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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002339
Report Date: 09/24/2024
Date Signed: 02/14/2025 03:40:04 PM

Document Has Been Signed on 02/14/2025 03:40 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:GARDEN VILLAFACILITY NUMBER:
315002339
ADMINISTRATOR/
DIRECTOR:		KAUR, KANWALPREETFACILITY TYPE:
740
ADDRESS:1104 NOTTINGHAM COURTTELEPHONE:
(916) 871-4682
CITY:ROSEVILLESTATE: CAZIP CODE:
95661
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
09/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:20 AM
MET WITH:CaregiverTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 9/24/24 to conduct a Annual Inspection utilizing the CARE inspection tool. LPA met with staff and explained the purpose of the visit. LPA requested for staff to notify Administrator that LPA is present at the facility to conduct an annual inspection. Administrator, Preety Kaur, arrived to assist

LPA toured the interior and exterior of the facility together with staff to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, bathroom, kitchen, laundry room, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed.

LPA and licensee discussed leaving hallway fire door unobstructed as well as pending repair to roof on the rear of the house.

5 resident and 2 staff files were reviewed. Licensee to send missing documents to LPA.

Additionally, licensee will send: Infection Control Plan, Emergency Plan, LIC 500, Resident roster, liability insurance and LIC 308s is applicable.

No deficiencies are being cited as a result of todays inspection.


Exit interview conducted and copy of report left at the facility.
Maribeth SentyTELEPHONE: (916) 263-4813
Kevin MknellyTELEPHONE: (209) 814-1925
DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/24/2024
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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