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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045001608
Report Date: 08/14/2023
Date Signed: 08/14/2023 10:29:33 AM


Document Has Been Signed on 08/14/2023 10:29 AM - 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:
08/14/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Natasha Leonard - administratorTIME COMPLETED:
10:45 AM
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08/14/2023 09:45 AM Licensing Program Analyst (LPA) Rebecca Knight arrived unannounced to conduct a health and safety visit. LPA met with Administrator Natasha Leonard.

LPA toured the facility with the administrator, 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. Residents had just finished eating breakfast. Snacks are offered at 10:00 AM, 2:00 PM and 8:00 PM and at resident request throughout the day. Facility was observed to be at a comfortable temperature. LPA observed locked medication room. All cleaning supplies and toxins are locked in a closet and inaccessible 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: 08/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/14/2023
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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