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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
315920021
Report Date:
09/26/2024
Date Signed:
09/26/2024 01:02:52 PM
COMPREHENSIVE INSPECTION
Document Has Been Signed on
09/26/2024 01:02 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 VILLA
FACILITY NUMBER:
315920021
ADMINISTRATOR/
DIRECTOR:
KAUR, NIRMALJEET
FACILITY TYPE:
740
ADDRESS:
6893 CHERRY RIDGE CIR.
TELEPHONE:
(916) 786-0654
CITY:
ROSEVILLE
STATE:
CA
ZIP CODE:
95678
CAPACITY:
6
CENSUS:
6
DATE:
09/26/2024
TYPE OF VISIT:
Case Management - Annual Continuation
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:
Baljeet Singh
TIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On 9/26/24. LPA Kevin Mknelly arrived to complete the inspection and documents for the Annual inspection begun 9/25/24.
Reports completed and citations issued are recorded for 9/25/24 and report provided
SUPERVISORS NAME
:
Maribeth Senty
LICENSING EVALUATOR NAME
:
Kevin Mknelly
LICENSING EVALUATOR SIGNATURE
:
DATE:
09/26/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/26/2024
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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