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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315001936
Report Date: 11/25/2024
Date Signed: 11/25/2024 09:55:21 AM

Document Has Been Signed on 11/25/2024 09:55 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
Lookup Error,
, CA
FACILITY NAME:TAJ RESIDENTIAL CARE IIIFACILITY NUMBER:
315001936
ADMINISTRATOR/
DIRECTOR:		IGOR KOSTHANDINOVICFACILITY TYPE:
740
ADDRESS:7088 LUDLOW DRIVETELEPHONE:
(916) 781-6199
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY: 6CENSUS: 6DATE:
11/25/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Geena JudgeTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
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Licensing Program Analysts (LPAs) Vincent Moleski and Holly Williams arrived unannounced to conduct a collateral visit. LPAs Moleski and Williams met with facility administrator Geena Judge and explained the purpose of the visit.

LPA Williams interviewed a resident (R1).

No deficiencies were cited during this visit. An exit interview was held and a copy of this report was left with Judge.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE: DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/25/2024
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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