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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 577005609
Report Date: 08/01/2023
Date Signed: 08/01/2023 01:48:50 PM


Document Has Been Signed on 08/01/2023 01:48 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:PALM GARDENSFACILITY NUMBER:
577005609
ADMINISTRATOR:LAUREN ANDERSENFACILITY TYPE:
740
ADDRESS:240 PALM AVETELEPHONE:
(530) 661-0574
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY:100CENSUS: 63DATE:
08/01/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Lauren Andersen, AdministratorTIME COMPLETED:
01:50 PM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct an inspection regarding the health and wellness check of the residents and building.

LPA Nakagawa found the facility clean and orderly. The temperature of the facility was between 73 and 74 F. 10 out of 10 rooms surveyed had water temperature between 105 and 120 F, which is within regulation. The kitchen and dining room were clean and sanitized. There was an ample supply of perishable and non-perishable foods. The med room was clean and well-organized; and all medications were locked and secured. The memory care unit was clean and odor-free; rooms were well-organized and bathrooms were clean and sanitary.
The activity room was operating, with 8-10 residents participating in a game together. There were residents enjoying the the shaded courtyard. There was ample staffing and residents were clean and appropriately dressed. Overall, both residents and staff were cordial and interactive.

There were no deficiencies found at the time of this inspection.
No citations issued.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Jill NakagawaTELEPHONE: 707-588-5063
LICENSING EVALUATOR SIGNATURE:
DATE: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/01/2023
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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