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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 577001978
Report Date: 06/21/2022
Date Signed: 06/21/2022 12:01:23 PM


Document Has Been Signed on 06/21/2022 12:01 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:ANISIA'S HEALTHY LIVINGFACILITY NUMBER:
577001978
ADMINISTRATOR:BURRESS, SVETLANAFACILITY TYPE:
740
ADDRESS:1904 MICHIGAN BLVD.TELEPHONE:
(916) 372-3174
CITY:WEST SACRAMENTOSTATE: CAZIP CODE:
95691
CAPACITY:6CENSUS: 0DATE:
06/21/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Svetlana Burress, LicenseeTIME COMPLETED:
12:10 PM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct an inspection regarding the opening of the facility.

LPA found the facility to be clean and a comfortable temperature. The rooms were in the process of being furnished for future residents. LIcensee passed fire inspection on May 31, 2022, and received approval for six residents, two of whom may be hospice.

The facility is ready for occupancy. The Licensee is now working on staffing.

There were no deficiencies found on the time of this visit.
No citations issued.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Jill NakagawaTELEPHONE: 707-588-5063
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2022
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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