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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045001798
Report Date: 09/11/2024
Date Signed: 09/11/2024 10:58:21 AM

Document Has Been Signed on 09/11/2024 10:58 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:BEDFORD HOUSE, THEFACILITY NUMBER:
045001798
ADMINISTRATOR/
DIRECTOR:		COOK, AMYFACILITY TYPE:
735
ADDRESS:1878 BEDFORD DRIVETELEPHONE:
(530) 809-4099
CITY:CHICOSTATE: CAZIP CODE:
95928
CAPACITY: 6CENSUS: 4DATE:
09/11/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:11 AM
MET WITH:Administrator- Amy Cook TIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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On 09/11/2023, Licensing Program Analyst (LPA) Jaynae Boyles, arrived at the facility unannounced to conduct a 1-Year Required Annual Inspection. LPA met with Facility Administrator, Amy Cook and explained the purpose of the visit.

LPA Boyles 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. LPA observed the resident bedrooms to have all the required furnishings, working lights and windows with screens. LPA observed the bathrooms to have the necessary grab bars, non-skid flooring or shower chair, 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. LPA observed the weekly menus posted for residents to view. LPA observed the knifes, medications and chemicals to be locked and inaccessible to residents. Hot water temperature was measured within the required temperature range. LPA observed two (2) fire extinguishers, fire detectors, and carbon monoxide detectors throughout the facility. LPA observed a complete emergency first aid kit ready for use. LPA observed a completed emergency disaster plan and drills conducted as required.

LPA observed the facility to be clean, in good repair and odor-free. In the areas toured no immediate health, safety, or personal rights violations were observed.

LPA reviewed a total of four (4) residents' files and four(4 ) staff files which contained all the required documentation.

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: 09/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/11/2024
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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