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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045001608
Report Date: 08/08/2023
Date Signed: 08/08/2023 02:46:22 PM


Document Has Been Signed on 08/08/2023 02:46 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:COUNTRY HEARTSFACILITY NUMBER:
045001608
ADMINISTRATOR:LEONARD, CAROLFACILITY TYPE:
740
ADDRESS:7170 LOWER WYANDOTTE RD.TELEPHONE:
(530) 589-2466
CITY:OROVILLESTATE: CAZIP CODE:
95966
CAPACITY:15CENSUS: 9DATE:
08/08/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Murissa Rogers - care staffTIME COMPLETED:
03:00 PM
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08/082023 2:00 PM Licensing Program Analyst (LPA) Rebecca Knight arrived unannounced to conduct a helth and safety visit. LPA met with care staff Murissa Rogers and Angela Neal.

LPA toured the facility with care staff, all residents were at home during today's inspection. LPA observed there was a 2-day perishable, 7-day non-perishable amount of food available. LPA observed resident medications were being stored properly and being dispensed daily to residents. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA discussed a variety of topics.

No deficiencies cited during today's visit.

Exit interview conducted.
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:
DATE: 08/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/08/2023
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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