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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515001365
Report Date: 07/13/2023
Date Signed: 07/13/2023 02:42:40 PM


Document Has Been Signed on 07/13/2023 02:42 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:GARDENS, THEFACILITY NUMBER:
515001365
ADMINISTRATOR:BRANDY STRAHLFACILITY TYPE:
740
ADDRESS:840 WASHINGTON AVENUETELEPHONE:
(530) 790-3075
CITY:YUBA CITYSTATE: CAZIP CODE:
95991
CAPACITY:49CENSUS: 28DATE:
07/13/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Jamie ScottTIME COMPLETED:
02:52 PM
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LPA Hiratsuka conducted this case management visit in response to two separate incidents reported by the facility.

The first incident involved a resident who was found by the fire department just outside the property. This building has delayed egress. The facility administration did an investigation and they think the resident waited until a someone left the door and the resident ran out the door because the door does not lock right away. LPA asked if visitors are given the code to get and was told only facility staff are given the code. There is nothing in Title 22 regulations that require the code to be given to visitors and the facility is not. Health Services Director Jamie Scott stated all staff have been reminded to ensure the door is closed after anyone uses the door before walking away and signs have been posted.

The second incident involves two residents: one who lives here and one who lives at The Courtyard, which is behind this building. The Courtyard is not a memory care facility. The resident who lives there had the one who lives here over as a guest and the resident who lives here was told to leave while over there and made it to a relative's house after being told to leave. The visitation rules for the resident who lives here has been adjusted to meet the resident's needs without violating the personal rights.

No deficiencies cited
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:
DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/13/2023
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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