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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045002224
Report Date: 12/15/2022
Date Signed: 12/15/2022 02:33:19 PM


Document Has Been Signed on 12/15/2022 02:33 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:ALMOND BLOSSOM SENIOR CAREFACILITY NUMBER:
045002224
ADMINISTRATOR:RAMOS, EDUVIJESFACILITY TYPE:
740
ADDRESS:1036 BLACKMUIR COURTTELEPHONE:
(530) 342-1813
CITY:CHICOSTATE: CAZIP CODE:
95926
CAPACITY:6CENSUS: 6DATE:
12/15/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:CaregiverTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 12/15/22 to amend the report C and D pages dated 11/21/22. LPA met with caregiver and Emily Lanser and explained the purpose of the visit. Prior to initiating the complaint visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA completed a facility risk assessment upon arrival. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA was screened by facility staff upon entering the facility.

LPA amended the complaint findings to include civil penalty

No further deficiencies were noted during this visit.

report reviewed and copy provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:
DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/15/2022
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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