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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315920067
Report Date: 04/22/2024
Date Signed: 04/22/2024 01:54:39 PM

Document Has Been Signed on 04/22/2024 01:54 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:LOVE YOU DADFACILITY NUMBER:
315920067
ADMINISTRATOR/
DIRECTOR:		GERGI, EDUARDFACILITY TYPE:
740
ADDRESS:5024 SOUTHSIDE RANCH RDTELEPHONE:
(916) 807-4319
CITY:ROCKLINSTATE: CAZIP CODE:
95677
CAPACITY: 6CENSUS: 6DATE:
04/22/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Eduard GergiTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On Monday April 22, 2024, Licensing Program Analyst Melissa Parks arrived to conduct an unannounced postlicensing inspection..

LPA reviewed 2 resident and 1 staff file. All resident files contained the required paperwork. Staff file contained the required paperwork and training. Facility is current on fire drills.

LPA toured the facility with Administrator Eduard. The following areas were inspected: backyard, resident rooms, resident bathrooms, kitchen, and common area.

LPA obtained a copy of the current liability insurance.

No deficiencies cited. An exit interview conducted. A copy of this report was emailed.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE: DATE: 04/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/22/2024
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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