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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345920175
Report Date: 08/05/2024
Date Signed: 08/05/2024 11:41:30 AM


Document Has Been Signed on 08/05/2024 11:41 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, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:PALMS SENIOR LIVING, THEFACILITY NUMBER:
345920175
ADMINISTRATOR:KAUR, NAVGEETFACILITY TYPE:
740
ADDRESS:5512 WINDING WAYTELEPHONE:
(951) 775-4933
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: 0DATE:
08/05/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Navgeet Kaur TIME COMPLETED:
11:45 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
Licensing Program Analyst (LPA) Cassie Yang arrived at the facility to conduct a pre-licensing inspection. LPA met with Applicant, Navgeet Kaur and Harjit Rana, and explained the purpose of the visit.

During today's inspection, LPA and Applicant conducted a tour of the facility. Areas toured included but not limited to: kitchen, five residents bedrooms, one staff room/office, three bathrooms, laundry room, garage, backyard, storage rooms and the common areas. LPA observed the model rooms to be furnished with the required furniture. LPA observed door to have sensors to be on the resident exit doors. LPA observed knives to be locked and secured. LPA observed laundry room to have chemical and detergents to be locked and secured.

Comp III was waived and Applicant is a Administrator at other facilities.

Prelicensing inspection tool completed and found facility to be in compliance to CCR Title 22, Chapter 8. No deficiencies are being cited as a result of today's inspection.

LPA informed Applicant license is pending until notified otherwise.

Exit interview conducted and a copy of the report was provided.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: (916) 201-1928
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)
Page: 1 of 1