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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315920022
Report Date: 09/28/2023
Date Signed: 09/28/2023 09:52:10 AM

Document Has Been Signed on 09/28/2023 09:52 AM - 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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME:BMJ GARCIA CARE HOME 4FACILITY NUMBER:
315920022
ADMINISTRATOR:GARCIA, MARILOUFACILITY TYPE:
735
ADDRESS:8401 TRINIDAD WAYTELEPHONE:
(916) 612-5030
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY: 4CENSUS: 0DATE:
09/28/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Marilou Garcia, Administrator TIME COMPLETED:
10:10 AM
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Licensing Program Analyst (LPA) Bethany Mirlohi arrived announced to conduct a pre-licensing inspection. LPA met with Administrator Marilou Garcia during today's inspection. Currently there are no clients residing within the facility.

Facility was inspected both indoors and outdoors. LPA inspected 4 client bedrooms, 2 bathrooms, 1 staff room, common living areas, kitchen, garage, and outdoor areas. Outdoor area is free from hazardous debris. Outdoor exits are clear and accessible. First aid kit was present in the facility. Centrally stored medications will be locked in cabinet in the kitchen. LPA inspected client bedrooms and the bedroom had appropriate furnishings, adequate lighting and storage. Bathrooms are clean, sanitary, and in good repair. Smoke detectors and carbon monoxide detectors were checked and operational. Fire clearance was granted on 05/31/23 for 4 ambulatory clients. Kitchen is clean, sanitary, and in good repair. A working cellphone and internet is set up and available for clients. Hot water was measured at 106 degrees.

Licensee agrees to notify LPA once first consumer is admitted. This report will be forwarded to the centralized application unit for continued processing.

Exit interview conducted.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Bethany Mirlohi
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2023
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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