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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317005676
Report Date: 02/10/2021
Date Signed: 04/02/2021 04:01:17 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR., STE 270
SACRAMENTO, CA 95833
FACILITY NAME:GARDEN VILLAFACILITY NUMBER:
317005676
ADMINISTRATOR:GAODE, ANNAFACILITY TYPE:
740
ADDRESS:3908 RUTLAN WAYTELEPHONE:
(916) 772-1972
CITY:ROCKLINSTATE: CAZIP CODE:
95677
CAPACITY:6CENSUS: DATE:
02/10/2021
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Anna Gaode, LicenseeTIME COMPLETED:
02:30 PM
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On this date a meeting was held with licensee Anna Gaode to discuss the facility being taken over by the licensee's daughter. Present were Anna Gaode, LPM Laura Munoz, and Todd Tryon, LPA The meeting was held via video by Webex due to concerns related to COVID-19.

Ms. Gaode's daughter's facility in Orangevale, Oak Creek Home Care, will be closing, and they have made the decision that her daughter and son-in-law will take over this house and apply to open the facility under a new license in their name. Mrs. Gaode will remain the property owner and will do a lease to her daughter's LLC. The plan is that Mrs. Gaode will remain associated to the new license as an administrator.

The facility currently has 4 residents. They have already done 60 day notices and spoken with the residents and families, and they plan to stay on. They understand they will need to get new physician reports, sign a new contract with the new licensee, etc. The other facility will be moving 2 residents to the home. They have also been given notice, had meetings, etc. Ms. Munoz pointed out that the 2 residents moving from the other home will need to have COVID exams prior to the move. Arrangements have already been made for the hospice company for resident of the other home to deliver beds and equipment so it will be there when residents arrive. The move of the home has been arranged with a mover.

At this time it appears that the family has followed through on suggestions given previously and appear to be on track for the move. Mrs. Gaode will contact LPA with any questions or concerns.

Since this meeting was held virtually, LPA will send a copy of this report to Anna Gaode by e-mail. Mrs. Gaode is asked to print 2 copies of the report, sign both, keep one for her records, and return the other signed copy to CCL for licensing records. A copy of the signed document will be kept in the CCL hard file for Garden Villa.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 208-7709
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2021
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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