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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515001365
Report Date: 07/31/2023
Date Signed: 07/31/2023 10:01:53 AM


Document Has Been Signed on 07/31/2023 10:01 AM - 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: 32DATE:
07/31/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Jamie ScottTIME COMPLETED:
10:10 AM
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LPA HIratsuka, conducted this unannounced annual visit. LPA toured the facility with Nurse Manager Jamie Scott.

This facility has a non-ambulatory fire clearance. This facility has a delayed egress system. This facility shares a campus with a skilled nursing facility and the backside of the property is The Courtyard 515000683. The parking lot has a wrought iron fence and gate that automatically opens. The common areas were toured and several rooms were toured. No health, safety, and personal rights issues were observed.

Five resident files and staff training were reviewed during this visit.

Several topics were discussed.

No deficiencies cited.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:
DATE: 07/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/31/2023
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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