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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700964
Report Date: 01/23/2025
Date Signed: 01/23/2025 01:30:15 PM

Document Has Been Signed on 01/23/2025 01:30 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:GARDEN OF JOYFACILITY NUMBER:
342700964
ADMINISTRATOR/
DIRECTOR:		UWOGHIREN, DRUSILLAFACILITY TYPE:
740
ADDRESS:3908 BRANCH STREETTELEPHONE:
(510) 375-6903
CITY:SACRAMENTOSTATE: CAZIP CODE:
95838
CAPACITY: 6CENSUS: 5DATE:
01/23/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:06 PM
MET WITH:Drusilla UwoghirenTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
NARRATIVE
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Licensing Program Analysts (LPA) Holly Williams arrived unannounced to open a complaint and found other deficiencies in the process. LPA Williams spoke with facility administrator Drusilla Uwoghiren and explained the purpose of the visit.

On arriving on 1/23/25 LPA Williams observed that S1 was not associated and none of the caregivers had files including the administrator. The housekeeper S4 had an ID and a clearance. LPA Williams is referring Uwoghiren to TSP on their request.

This facility is being cited per 22 CCR sections 87355(e)(3), 87412(a). LPA assessed civil penalties for not associating staff member S1. Civil penalties are being assessed for $500 for 1 staff member not associated.

An exit interview was held with Uwoghiren. Appeal rights and a copy of this report were left with Uwoghiren.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Holly Williams
LICENSING EVALUATOR SIGNATURE: DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2025
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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Document Has Been Signed on 01/23/2025 01:30 PM - It Cannot Be Edited


Created By: Holly Williams On 01/23/2025 at 01:04 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GARDEN OF JOY
FACILITY NUMBER: 342700964

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/24/2025
Section Cited
CCR
87355(e)(3)

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87355(e) All individuals subject to a criminal record pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (3) 87356(r)...
This requirement was not met as evidenced by:
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Licensee agrees to send a statement of understanding that Licensee understands title 22 regulations 87355(e)(3) on what needs to be included in a staff file. Licensee will have 3 weeks from POC due date to get all files complete and S1 associated. Holly.williams@dss.ca.gov
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Based on observation and record review, and S1 was not associated with the facility which poses an immediate health, safety and/or personnel rights risk.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME:Holly Williams
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/23/2025 01:30 PM - It Cannot Be Edited


Created By: Holly Williams On 01/23/2025 at 01:06 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GARDEN OF JOY
FACILITY NUMBER: 342700964

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/24/2025
Section Cited
CCR
87412(a)

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87412 Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee...
This requirement was not met as evidenced by:
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Licensee agrees to have all files and training completed by POC due date. Holly.Williams@dss.ca.gov
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Based on observation and record review none of the employees or administrator has a personnel file which poses an immediate health, safety and/or personnel rights risk.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME:Holly Williams
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2025


LIC809 (FAS) - (06/04)
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