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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 581374501
Report Date: 04/28/2023
Date Signed: 04/28/2023 04:07:22 PM

Document Has Been Signed on 04/28/2023 04:07 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:ALMA AMAYA'S FAMILY HOMEFACILITY NUMBER:
581374501
ADMINISTRATOR:HOUSTON, MICHAELFACILITY TYPE:
735
ADDRESS:1716 8TH AVENUETELEPHONE:
(530) 742-3997
CITY:OLIVEHURSTSTATE: CAZIP CODE:
95961
CAPACITY: 5CENSUS: 1DATE:
04/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:23 PM
MET WITH:Alma AmayaTIME COMPLETED:
03:30 PM
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Licensing Program Analysts (LPA) Sarah Benson arrived on Thursday April 27, 2023 at 1:23 pm to conduct an unannounced annual inspection.

During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPAs reviewed client (1) and staff (2) files. All resident files contained the required paperwork. All staff files contained the required paperwork and training.

LPAs and licensee Alma Amaya toured the facility together to ensure the health and safety of clients in care. The areas toured included bedrooms, kitchen, bathroom, and backyard. In the areas toured, there were no health or safety violations observed.

No deficiencies cited. Exit interview conducted. A copy of this report was emailed to the Licensee.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sarah Benson
LICENSING EVALUATOR SIGNATURE: DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/28/2023
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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