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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
515002742
Report Date:
08/20/2024
Date Signed:
08/20/2024 02:16:24 PM
Document Has Been Signed on
08/20/2024 02:16 PM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC
,
9835 GOETHE ROAD, SUITE 100
SACRAMENTO
,
CA
95827
FACILITY NAME:
YUBA SUTTER CARE HOME INC.
FACILITY NUMBER:
515002742
ADMINISTRATOR:
KAUR, RAJVEER
FACILITY TYPE:
740
ADDRESS:
920 BOGUE ROAD
TELEPHONE:
(530) 777-6476
CITY:
YUBA CITY
STATE:
CA
ZIP CODE:
95991
CAPACITY:
6
CENSUS:
5
DATE:
08/20/2024
TYPE OF VISIT:
Office
ANNOUNCED
TIME BEGAN:
01:30 PM
MET WITH:
Rajveer Kaur and Manpreet Dyal
TIME COMPLETED:
02:20 PM
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This office meeting was conducted at the request of Licensees
Rajveer Kaur and Manpreet Dyal. They wanted to review floor plans for their new location and discuss change of location. Present from Community Care Licensing were Licensing Program Analysts Hiratsuka and Gunby and Licensing Program Manager Troy Ordonez.
Discussed was change of location procedures and the floor plan. Licensees were advised to reach out to the Central Application Bureau for more information. Licensees are also to keep LPA Hiratsuka updated on the progress.
SUPERVISOR'S NAME:
Troy Ordonez
TELEPHONE:
(916) 263-4700
LICENSING EVALUATOR NAME:
Kerry Hiratsuka
TELEPHONE:
(916) 591-0210
LICENSING EVALUATOR SIGNATURE:
DATE:
08/20/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/20/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
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