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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006622
Report Date: 12/09/2024
Date Signed: 12/09/2024 01:27:35 PM

Document Has Been Signed on 12/09/2024 01:27 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:SATAKASH CAREFACILITY NUMBER:
306006622
ADMINISTRATOR/
DIRECTOR:		KAUR, GAGAN DEEPFACILITY TYPE:
740
ADDRESS:7440 RIDGEWAY DRTELEPHONE:
(562) 239-6507
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 6CENSUS: 0DATE:
12/09/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Gagan KaurTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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Licensing Program Analysts (LPA) Jerome Haley made an announced visit for the purpose of conducting a pre-licensing evaluation. LPA Haley was greeted and granted entry by applicant Gagan Kaur.

Initial application: To operate a Residential Care Facility for the Elderly, with a capacity of 6 non ambulatory residents of which, one may be bedridden was submitted to the department for licensure.



Fire clearance: Orange County Fire Authority granted the fire clearance October 4, 2024.

Structure: The facility is a single level structure, with an attached garage. There’s a total of 4 bedrooms: 3 bedrooms for residents & 1 bedroom (#2) is for staff. One living room space, one dining area, and two bathrooms. Bedrooms (Residents): All bedrooms have the required furnishings: bed, lamp, chair, and storage space. Bathroom(s): Bathrooms are equipped with a working toilet, wash basin, and shower. Hot water temperature measured in the range of 115.5 – 116.0 degrees Fahrenheit. Kitchen: 4 of 4 burners, the fan, and the light were operational on the gas stove. Sharps are kept locked in a cabinet above the refrigerator. No cleaning chemicals were being stored in the kitchen at the time of the inspection. Food Service: LPA Haley observed a well stocked supply of perishable and non-perishable food items. An additional non-perishable food supply was observed in the garage. A sample menu was posted on the refrigerator. Laundry: There's a laundry area in the garage equipped with a washer and dryer. Toxins: All toxic chemicals, soaps, detergents, and cleaning solutions are inaccessible to residents and locked in a filing cabinet in the garage. Resident & Staff Files: Resident and staff files will be stored in a locked filing cabinet near the dining table in the dining room.
Medications/First-Aid Kit: Client medications will be stored in the kitchen in a locked cabinet above the counter.
Continued on LIC809C
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE: DATE: 12/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: SATAKASH CARE
FACILITY NUMBER: 306006622
VISIT DATE: 12/09/2024
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Linens & Hygiene Supplies: There’s a hallway closet with a supply of linens, and hygiene items. There’s additional linens stored in a cabinet in the master bathroom.

Backyard/Exterior: The backyard is clean and organized. Plenty of seating and a table was observed under a shaded patio area. All walkways were clear and free of obstruction. The side exit gate is self-latching.

Bodies of Water: N/A. No bodies of water observed.

Smoke/Carbon Monoxide Detectors: Smoke and carbon monoxide detectors tested operational.

Fire Extinguisher: One fire extinguisher was observed mounted on the wall in the kitchen next to the garage door. Another fire extinguisher was observed in the main hallway mounted on the wall.

Emergency Phone Numbers, House Rules, Exit Plan & Menu: Several facility postings were posted on a wall in the hallway and readily available for review: Personal rights, facility menu, facility sketch, LIC500, resident roster, house rules, and a list of emergency phone numbers.

Component III: Presented to applicant Gagan Kaur.

There are no corrections needed. The facility is ready to be licensed and will be recommended for licensure.
An exit interview was conducted, and a copy of this report was provided to applicant Gagan Kaur.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2024
LIC809 (FAS) - (06/04)
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