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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003429
Report Date: 10/22/2020
Date Signed: 10/22/2020 02:53:04 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:SKY PARK GARDENSFACILITY NUMBER:
347003429
ADMINISTRATOR:SHERRY RICHARDSONFACILITY TYPE:
740
ADDRESS:5510 SKY PARKWAYTELEPHONE:
(916) 422-5650
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY:144CENSUS: DATE:
10/22/2020
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
02:43 PM
MET WITH:Sherry RichardsonTIME COMPLETED:
02:55 PM
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Licensing Program Analyst (LPA) Suong Teh contacted the facility via telephone to commence an unannounced tele-visit on 10/22/2020 @1443 hours due to COVID-19 and pre-cautionary measures. LPA spoke with administrator Sherry Richardson and discussed the purpose of the call and the elements of this type of visit. Today's date for the purpose of delivering an Order to Individual of Immediate Exclusion from all facilities and the Order to Licensee/Facility of Immediate Exclusion From Facility.


LPA Teh spoke with Sherry Richardson and explained the purpose of today's visit. Staff, Kim Atkinson is excluded as a result of her actions related to this facility.

LPA Teh discussed the Order to Facility Staff of Immediate Exclusion from the Facility and explained that staff, Kim Atkinson cannot come to the facility after the five day protective order is expired and cannot be allowed to work, be present and/or live in a CCL licensed facility or have contact with clients in any residential facility or child day care licensed by the California Department of Social Services.

The Licensee was provided a copy of their rights (LIC9058) and their signature on this form acknowledges receipt of these rights. An exit interview was conducted with administrator Sherry Richardson via telephone and a copy of this report was provided via email.

SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Tuyet-Suong TehTELEPHONE: (916) 709-6830
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2020
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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