<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700215
Report Date: 10/03/2022
Date Signed: 10/03/2022 09:25:52 AM

Document Has Been Signed on 10/03/2022 09:25 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:ROSE GARDEN CARE HOMEFACILITY NUMBER:
342700215
ADMINISTRATOR:ANNABELLA PAULA VILEAFACILITY TYPE:
740
ADDRESS:3442 NORRIS AVENUETELEPHONE:
(916) 487-1589
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY: 5CENSUS: 0DATE:
10/03/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Annabella Vilea TIME COMPLETED:
09:28 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 10/03/22 at 9:00 AM, Licensing Program Analyst (LPA) Avelina Martinez arrived at this facility announced to conduct an inspection proceeding the closure of the facility. LPA met with Annabella Vilea, and explained the purpose of the visit.

As of today, the facility is closed. LPA Martinez toured the facility with Annabella at today's visit. All residents have moved to their new facility. Moreover, LPA Martinez went over the closure with Annabella, and Informed Anabella about the closure Survey Monkey www.surveymonkey.com/r/facilityclosure. LPA Martinez obtained the facility License.

An exit survey was conducted, and a copy of this report was given to Annabella Vilea.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1