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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003429
Report Date: 06/30/2021
Date Signed: 06/30/2021 12:35:43 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: 85DATE:
06/30/2021
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
12:03 PM
MET WITH:Sherry RichardsonTIME COMPLETED:
01:00 PM
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On 06/30/21 at 12:03 PM, Licensing Program Analyst (LPA) Suong Teh and LPA Christina Valerio arrived unannounced to conduct a case management visit. LPAs met with Administrator Sherry Richardson and Assistant Administrator Susan McClure. Sherry stated the stipulation letters (letter of intent) have been given to the residents and/or responsible parties as of yesterday 06/29/21.

LPAs were screened for COVID-19 symptoms and temperature taken prior to being allowed entry into the facility. LPAs toured the facility to ensure compliance with Title 22 regulations. Medication room was locked, staff offices were organized, hallways were clear from obstructions, rooms were furnished and clean, and there was no odor throughout the facility. LPAs observed all staff wearing masks, hand sanitizer stations were mounted throughout the facility, and COVID-19 informational signs were posted.

No deficiencies were observed. Exit interview was held Administrator Sherry Richardson and Assistant Administrator Susan McClure and a copy of the report was left.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2021
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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