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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803612
Report Date: 06/21/2021
Date Signed: 06/21/2021 12:23:59 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:GARDEN OF EDENFACILITY NUMBER:
486803612
ADMINISTRATOR:MILTON, SHERYLFACILITY TYPE:
740
ADDRESS:115 MENLO COURTTELEPHONE:
(707) 654-8307
CITY:VALLEJOSTATE: CAZIP CODE:
94589
CAPACITY:6CENSUS: 2DATE:
06/21/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Steven Milton, LicenseeTIME COMPLETED:
12:00 PM
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Licensing Program Analysts (LPA's) Tobola and Lopez conducted an unannounced Annual Required – 1 yr. Infection Control inspection for this facility and met with Licensee Steven Milton (SM). The facility currently provides care for 2 residents none of which have a diagnosis of dementia.

LPA's arrived at the facility and had temperature checked and logged. LPA's continued with a tour of the facility with Licensee; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was found to be last charged on 6/7/2021 at the time of the visit. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Toxins are stored in a locked cabinet in the facility kitchen and garage. LPA's observed insect spray located on top of the refrigerator accessible to residents which was immediately removed. There was a supply of cleaners, hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings.

Infection Control:
Facility has not submitted a mitigation program plan. However, LPA's requested for Licensee to create mitigation program plan and was reviewed and approved at the time of visit. Posters have been placed at the front door, and facility has a station at main entrance with a sign in sheet, hand sanitizer and other items designated for visitors and staff. Staff and residents are screened for temperature and symptoms on a daily basis and recorded.

No deficiencies cited during today's visit. Appeal Rights Given.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Dominic TobolaTELEPHONE: (707) 588-5081
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2021
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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