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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701422
Report Date: 12/11/2024
Date Signed: 12/11/2024 12:07:00 PM

Document Has Been Signed on 12/11/2024 12:07 PM - 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:SAN GABRIEL RESIDENCEFACILITY NUMBER:
502701422
ADMINISTRATOR/
DIRECTOR:
SANDHU, JEEVANJOATFACILITY TYPE:
735
ADDRESS:1801 SAN GABRIEL DR.TELEPHONE:
(209) 531-6694
CITY:HUGHSONSTATE: CAZIP CODE:
95326
CAPACITY: 4CENSUS: 0DATE:
12/11/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Jeevanjoat Sandhu, Licensee/AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 12/11/24, Licensing Program Analyst (LPA) Renee Campbell arrived announced to the facility for a pre-licensing follow up visit regarding requested corrections. LPA Campbell met with the licensee Jeevanjoat Sandhu and explained the purpose of the visit.

Upon entry, LPA Campbell observed a 'See Something, Say Something' poster in the living room. The licensee purchased additional furniture for the office and living room areas. An Administrator Certificate was also available for display in the facility. No residents were present in the facility.

Mattresses and drawers were observed in the client bedrooms with sheets and comforters. Clients will all have their own bedrooms. Except for Bedrom #1, all beds will be twins. Bedroom #1 has a full size bed.

LPA Campbell used the facility phone and confirmed that the line was active. Bathrooms were added to the facility sketch for accuracy. LPA Campbell measured the hot water in the kitchen again and it was observed to be 120.7 degrees Fahrenheit, well withing the required range of 105 degree F (41 degree C) and not more than 120 degree F (49 degree C).

LPA inspected the exterior of the facility. LPA observed no outbuildings or bodies of water. All screens and gutters, along with the fence surrounding the property were in good repair.
There were no deficiencies observed during this visit.

A copy of this report was provided. Exit interview
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/11/2024
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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