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                                             Administrators  Invitation

 

 

Would you like to be part of our preferred Assisted Living /Board and Care homes? We invite you to inform us of your facility (s). Our procedure is simple. Fill out the form below and we will schedule a tour of your facility. We will perform an onsite inspection to assess the level of care you are performing as well as the cleanliness's and pleasantness of the surroundings for clients. We will also verify with the State of California. your licenses status for our clients protection. We look forward to working with you and assisting you in placements. Our Staff will be contacting you in the future for a convenient time for touring.

We service all areas of California so feel free to join our team no matter where you are in the state. For those who are out of state we will be glad to work with you and place our out of state clients in your area.

Also Join the Gallery of Homes
  • You can list your out of state home in our Gallery of Homes for a flat fee. Please fill out the form below and we will contact you with more information. Remember we can link to your site if you have one. The cost is much more affordable than any paper advertising. We will need 4 photos for the Gallery, they may be sent or emailed to the office.

We will fax you a contract and check all reference you provide. Thank you for your cooperation and assistance.

  *Required Fields

 

 

 

 

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New Facilities Only


 

   * Name of Facility   

  * Address  

  * City        *State       *Zip

   *Phone    * Fax     *Email

   *Owners Name    Owners Cellular

   Owners Home#          * License Number

   Administrator     Marketing Director

   Accounts Payable Contact  

   Please answer all that applies to your facility.  Make a choice for drop down menus.

    Assisted Living (Large Facility)      Board & Care 6 beds      Room and Board    

   Mentally Disabled 18-59          # Beds   

   Independent Living      Retirement      

    2nd diagnosis not primary for :  Dementia          Alzheimer      Hospice Waiver

   Separate Memory Care Unit             Gated             Alarms on doors

   Combative clients        Wanderers         Sundowner      Smokers allowed outside

   Diabetic         Insulin        Diabetic Diet       Oxygen  

   Incontinent         Catheters     Colostomy      Dialysis Client

   Bi Polar     Depression      Respites       Stand By Assist         Max Transfer

   Slider Board         Walker and Wheelchairs welcome?      Transport to appt    RN/LVNs on Staff

   Wounds:   1st    2nd          Activities     Pets allowed    Level of Care

   SNF attached to AL     More home?    Population   Do you have a PM staff that is awake?

Please list the price of a semi-private first.

   Studios   * Price:  Kitchens     Partial Kit

   One Bdrm   * Price:    Kitchens   Partial Kit

   2 Bdrm        Price:   Kitchens   Partial Kit

   Cottages Price:   Kitchens   Partial Kit

   Do you have               All Privates?             Shared units?

   SSI clients        Non Refundable Deposits           Community Fee

    Comments or Amenities

    Directions

  

Thank you for your time and we look forward to a good working relationship. For any questions regarding this form you may call the office at (916) 723-3038.

Sincerely,

 

Marie Batis

Administrator