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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 312700115
Report Date: 07/29/2025
Date Signed: 07/29/2025 02:24:17 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/28/2025 and conducted by Evaluator Cassandra Mikkelson
COMPLAINT CONTROL NUMBER: 59-AS-20250728101949
FACILITY NAME:WATERFORD RESIDENTIAL INCFACILITY NUMBER:
312700115
ADMINISTRATOR:JUDGE, GURDIPFACILITY TYPE:
740
ADDRESS:2588 WATERFORD CIRCLETELEPHONE:
(916) 213-2792
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY:6CENSUS: 6DATE:
07/29/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Gurdip Judge, AdministratorTIME COMPLETED:
10:35 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensed Program Analyst (LPA) Cassandra Mikkelson arrived at the facility to conduct a complaint investigation. LPA met with Administrator Gurdip Judge and explained the purpose of today's visit.

During the course of the investigation, it was determined that the resident is no longer residing at the facility. The allegations in question did not occur at this facility.

LPA collected documents, toured the facility and conducted interviews during the investigation.

Based on interviews conducted and records reviewed, the above allegation is found to be UNFOUNDED. A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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