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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701553
Report Date: 02/26/2025
Date Signed: 02/26/2025 05:59:02 PM

Document Has Been Signed on 02/26/2025 05:59 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:LAKEWOOD VILLA CARE CENTERFACILITY NUMBER:
342701553
ADMINISTRATOR/
DIRECTOR:		SINGH, ANGELINEFACILITY TYPE:
740
ADDRESS:8708 GERBER ROADTELEPHONE:
(916) 682-2867
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY: 18CENSUS: 12DATE:
02/26/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:40 PM
MET WITH:Shreetika ChandTIME VISIT/
INSPECTION COMPLETED:
06:00 PM
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On 2/26/25 at 1:40pm Licensing Program Analyst (LPA) Kevin Gould Conducted an unannounced pre-licensing, change of ownership inspection at Lakewood Villa Care Center LPA met with appointed administrator Shreetika Chand.

LPA conducted a walk through of the facility and observed several deficiencies while conducting the inspection.
  • Two staff member (S1 & S2) has a criminal record clearance but was not associated to the facility.
  • Two staff members (S3 & S4) do not have a health screening or TB clearance
  • Furniture: dressers in multiple resident bedrooms were missing drawers or had drawers that were not operable.
  • LPA observed thee knives, bleach unsecured from residents in care.
  • Hot water temperature exceeded 150 degrees F.
  • Residents identified as non ambulatory are residing in rooms designated for ambulatory residents per fire clearance. R1, R2, R3 and R4 all need to be moved to appropriate rooms based on their ambulatory status and the facility fire clearance.

Due to time constraints LPA was unable to complete the inspection and will return at a later date to complete the inspection. At the time of this inspection the facility does not meet the requirements to be licensed.

Exit interview conducted and a copy of this report was left at the facility
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Kevin Gould
LICENSING EVALUATOR SIGNATURE: DATE: 02/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/26/2025
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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