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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701553
Report Date: 04/22/2026
Date Signed: 04/22/2026 04:59:20 PM

Document Has Been Signed on 04/22/2026 04:59 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: 18DATE:
04/22/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:10 PM
MET WITH:Charlotte LewisTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
NARRATIVE
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On April 22, 2026, Licensing Program Analyst, Arvin Villanueva (LPA), arrived unannounced at this facility to conduct the annual inspection visit. LPA met with Charlotte Lewis and stated the purpose of the visit. Charlotte identified herself as the new administrator since February 2026. Per review of Guardian, she was associated to this facility on January 17, 2026.

Overview: Facility is a one-story building located in a residential neighborhood. Facility is licensed to serve up to 18 elderly residents, 9 of which may be non-ambulatory and 6 may be bedridden. Facility has a hospice waiver up to 18 residents. Facility does manage residents’ cash resources. Facility does not have delayed egress, and/or locked interior/exterior.

Physical Inspection: Areas inspected include, but not limited to, the kitchen, resident bedrooms, resident bathrooms, living and dining room and outdoor areas.

LPA inspected 5 of 9 resident bedrooms and 2 of 5 bathrooms. Room temperature was maintained at 73 degrees F. The hot water temperature was measured at 112 degrees Fahrenheit. 3 fire extinguishers were observed throughout the building. LPA observed sprinkler system. Smoke and carbon monoxide detectors were observed throughout.

In the kitchen, the facility maintained at least a seven-day supply of non-perishable foods and a two-day supply of perishable foods. Cleaning supplies, dish soaps, aerosol spray cans, and dish detergents were observed accessible inside unlocked cabinet located under the stove.

NAME OF LICENSING PROGRAM MANAGER: Stephen Richardson
NAME OF LICENSING PROGRAM ANALYST: Arvin Villanueva
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/22/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 04/22/2026 04:59 PM - It Cannot Be Edited


Created By: Arvin Villanueva On 04/22/2026 at 04:31 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: LAKEWOOD VILLA CARE CENTER
FACILITY NUMBER: 342701553

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/22/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/23/2026
Section Cited
CCR
87203

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All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This is not met as evidenced by:
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Per discussion, Administrator will removed all the three padlocks from the three gates. A photo will be sent to the Department as evidence of correction by POC due date.
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Based on observation and interview, the licensee did not maintain proper fire clearance by padlocking the outside emergency gate at the backyard near the parking lot. This poses an immediate health, safety, and personal rights risks to persons in care.
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Type A
04/23/2026
Section Cited
CCR87309(a)

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Storage Space and Access Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.
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Per discussion, the administrator will put lock on all cabinets where they store dangerous items. A photo will be sent to the Department as evidence of correction by POC due date.
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This requirement is not met as evidenced by: Based on observation, cleaning solutions, disinfectants, detergents, hygiene and other similar items were found accessible in the kitchen and laundry room. This poses an immediate health, safety, and personal rights risks to persons in care.
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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.
Stephen Richardson
NAME OF LICENSING PROGRAM MANAGER:
Arvin Villanueva
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/22/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/22/2026


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 CENTER
FACILITY NUMBER: 342701553
VISIT DATE: 04/22/2026
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Laundry room was inspected. Laundry soaps and hygiene supplies were observed in an accessible cabinet. The lock of the cabinet can be opened without a key. Other cleaning supplies were also in a cabinet that was accessible to residents.

Outdoor area was inspected. LPA observed covered areas with outdoor furniture. Ramps, fence, and exit gate were observed to be in good repair at this time. LPA observed the 3 exit gates at the back to be locked with padlocks.

Based on today’s visit, this annual inspection will require a continuation visit. The Department will return at a later date to continue the inspection.

Deficiencies are being cited based on today’s visit. Immediate Civil Penalty in the amounth of $500 was issued today due to fire safety violation.

Exit interview was conducted and a copy of this report and appeal rights were provided.

NAME OF LICENSING PROGRAM MANAGER: Stephen Richardson
NAME OF LICENSING PROGRAM ANALYST: Arvin Villanueva
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026
LIC809 (FAS) - (06/04)
Page: 4 of 4