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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045001798
Report Date: 09/18/2023
Date Signed: 09/18/2023 12:59:00 PM

Document Has Been Signed on 09/18/2023 12:59 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:BEDFORD HOUSE, THEFACILITY NUMBER:
045001798
ADMINISTRATOR:COOK, AMYFACILITY TYPE:
735
ADDRESS:1878 BEDFORD DRIVETELEPHONE:
(530) 809-4099
CITY:CHICOSTATE: CAZIP CODE:
95928
CAPACITY: 6CENSUS: 4DATE:
09/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Administrator Amy CookTIME COMPLETED:
01:15 PM
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On 08/18/2023, Licensing Program Analysts (LPAs) Jaynae Boyles and Ivan Avila, arrived at the facility unannounced to conduct a 1-Year Required Annual Inspection. LPAs met with Facility Administrator, Amy Cook and explained the purpose of the visit.

LPAs and Administrator toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, garage, backyard, and common restrooms. LPAs observed the facility to be clean, in good repair and odor-free and each bathroom to have the necessary grab bars, non-skid flooring, paper towels, trash can with lids and 20-second hand-washing poster. Facility has a 2-day perishable and a 7-day non-perishable amount of food and sharps to be locked. Hot water temperature was measured at 105 F. LPAs observed one fire extinguisher, fire detectors, and carbon monoxide detectors. In the areas toured no immediate health, safety, or personal rights violations were observed.

LPA reviewed a total of four (4) residents' files and three (3) staff files.

Several topics were discussed.

No deficiencies are being cited as a result of today’s inspection.

Exit interview conducted and copy of report left at the facility.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Jaynae Boyles
LICENSING EVALUATOR SIGNATURE: DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/18/2023
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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