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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
198603565
Report Date:
09/12/2023
Date Signed:
09/12/2023 12:29:47 PM
Document Has Been Signed on
09/12/2023 12:29 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
GREATER LA AC/SC
,
1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK
,
CA
91754
FACILITY NAME:
PEACEFUL GARDENS 2
FACILITY NUMBER:
198603565
ADMINISTRATOR:
KNAPP, GREGG A
FACILITY TYPE:
740
ADDRESS:
209 E CAMDEN ST
TELEPHONE:
(909) 406-3711
CITY:
GLENDORA
STATE:
CA
ZIP CODE:
91740
CAPACITY:
6
CENSUS:
5
DATE:
09/12/2023
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
11:44 AM
MET WITH:
Gregg Knapp
TIME COMPLETED:
12:39 PM
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LPA made announced visit to complete annual inspection and was not able to complete it due to death in the family of Licensee.
LPA will return to complete annual another day.
Copy of report provided to Licencee Gregg Knapp.
SUPERVISOR'S NAME:
Lisa Hicks
TELEPHONE:
(323) 981-3972
LICENSING EVALUATOR NAME:
Alberto Lopez
TELEPHONE:
323-980-4926
LICENSING EVALUATOR SIGNATURE:
DATE:
09/12/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/12/2023
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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