<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525002754
Report Date: 05/25/2023
Date Signed: 05/31/2023 12:54:00 PM


Document Has Been Signed on 05/31/2023 12:54 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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833



FACILITY NAME:PLEASANT PLACEFACILITY NUMBER:
525002754
ADMINISTRATOR:MARSHALL, ALLAN A.FACILITY TYPE:
740
ADDRESS:411 HYLAND DRIVETELEPHONE:
(530) 838-9244
CITY:CORNINGSTATE: CAZIP CODE:
96021
CAPACITY:6CENSUS: 5DATE:
05/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Allan MarshallTIME COMPLETED:
11:04 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
LPA Hiratsuka, conducted this unannounced annual visit. LPA toured the facility with Administrator Allen Marshall. Common areas, resident rooms, kitchen, backyard were all toured and no health and safety issues found. There is a pool in the backyard that is fenced and empty.

This facility increased capacity effective 05/17/2023 from five to six non-ambulatory residents.

Due to computer program issue, LPA typed this report and obtained original signature on paper report. LPA shall enter the this report into the computer program into the online database when LPA returns to office and shall send a copy of it to Licensee.

No deficiencies cited.

SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:
DATE: 05/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/31/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1