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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
092700822
Report Date:
09/24/2021
Date Signed:
09/24/2021 01:03:49 PM
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office
,
520 COHASSET RD., STE. 170
CHICO
,
CA
95926
FACILITY NAME:
BLISSFUL GARDEN
FACILITY NUMBER:
092700822
ADMINISTRATOR:
SHERI KIMBRO
FACILITY TYPE:
740
ADDRESS:
4210 PRODUCT DRIVE
TELEPHONE:
(530) 313-0364
CITY:
CAMERON PARK
STATE:
CA
ZIP CODE:
95682
CAPACITY:
25
CENSUS:
10
DATE:
09/24/2021
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
12:30 PM
MET WITH:
Charnele Ulmer
TIME COMPLETED:
01:15 PM
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CM visit regarding follow up visit to inspect the removal of piled construction material and debris from an unoccupied room. Room has been cleared out and is ready for occupancy.
No deficiencies were cited during today's visit.
SUPERVISOR'S NAME:
Laura Munoz
TELEPHONE:
(916) 263-4743
LICENSING EVALUATOR NAME:
Michael Smith
TELEPHONE:
(916) 208-7807
LICENSING EVALUATOR SIGNATURE:
DATE:
09/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/24/2021
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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