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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315920021
Report Date: 12/12/2023
Date Signed: 12/12/2023 02:30:21 PM

Document Has Been Signed on 12/12/2023 02:30 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:CHERRY RIDGE VILLAFACILITY NUMBER:
315920021
ADMINISTRATOR:KAUR, NIRMALJEETFACILITY TYPE:
740
ADDRESS:6893 CHERRY RIDGE CIR.TELEPHONE:
(916) 786-0654
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY: 6CENSUS: 5DATE:
12/12/2023
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Baljeet SinghTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 12/12/23 to conduct a Post Licensing Inspection utilizing the CARE inspection tool. LPA met with the caregivers and Licensee,Baljeet Singh , and explained the purpose of the visit. .

LPA and personnel toured the interior and exterior of the facility together with staff to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedroom, med cabinet, kitchen and dining. In the areas toured no immediate health, safety, or personal rights violations were observed.

LPA reviewed resident files. Files were complete. LPA advised Needs and service plans are maintained and reviewed with residents/ responsible parties and for licensees to collaborate with Hospice for clear concise Hospice Care Plans.

Staff files were reviewed. Files are complete. LPA advised regarding experienced staff training transfers between facilities.

No deficiencies are being cited as a result of todays inspection.

Exit interview conducted. Report provided copy provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE: DATE: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2023
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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