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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 310301569
Report Date: 08/05/2024
Date Signed: 08/05/2024 02:20:04 PM

Document Has Been Signed on 08/05/2024 02:20 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, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:WATSON BOARD & CAREFACILITY NUMBER:
310301569
ADMINISTRATOR/
DIRECTOR:		WATSON, CHARLESFACILITY TYPE:
735
ADDRESS:1012 ENWOOD AVETELEPHONE:
(916) 782-2650
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY: 6CENSUS: 4DATE:
08/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:40 PM
MET WITH:Charles WatsonTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Melissa Parks arrived on Monday August 5, 2024 to conduct the unannounced annual inspection.

During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA Parks reviewed client (4) and staff (1) files. All client and staff files contained the required paperwork.

LPA Parks and Administrator Charles toured the facility together to ensure the health and safety of clients in care. The areas toured included bedrooms (3), kitchen, bathroom, laundry room, and backyard. All chemicals and toxins were kept locked and inaccessible to clients. Facility had a fire extinguisher with a current inspection tag. First Aid kit was observed as complete.

No deficiencies cited. Exit interview conducted. A copy of this report was emailed to the Administrator.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE: DATE: 08/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/05/2024
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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