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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045002504
Report Date: 11/07/2024
Date Signed: 11/07/2024 10:48:44 AM

Document Has Been Signed on 11/07/2024 10:48 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:NELSON HOMEFACILITY NUMBER:
045002504
ADMINISTRATOR/
DIRECTOR:
STEVEN CONNORSFACILITY TYPE:
735
ADDRESS:77 NELSON AVENUETELEPHONE:
(530) 353-3111
CITY:OROVILLESTATE: CAZIP CODE:
95965
CAPACITY: 6CENSUS: 6DATE:
11/07/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Nora Serrano - administratorTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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11/07/2024 09:35 AM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility unannounced to conduct a Required-1 Year inspection. LPA met with Administrator Nora Serrano # 7002659735 exp. 12/22/2025 and explained the purpose of the visit.

LPA Knight and the administrator toured the facility together to ensure the health and safety of clients in care. Areas toured include but are not limited to six (6) client rooms, common areas, three (3) bathrooms, kitchen, storage areas and back yard. Staff and resident files were reviewed. All employees requiring background checks are cleared.

Activities are planned on a calendar and clients are also assisted with individual and group activities of their choice. Bedding, linens, and towels for clients were observed and found to be clean and in good repair. There is an adequate supply of toiletries for the clients. Medication is locked in a cabinet.

The facility was observed to be at a comfortable temperature. Common area was clean and in good repair. All bedrooms had required furniture, bedding, and lighting. Bathrooms were clean and in good repair. Kitchen was clean and in good repair. Food appears to be stored and prepared properly. Facility has required (7) seven-day non-perishable and (2) day perishable supply of food. Fire extinguishers fully charged and inspected. Smoke detectors are all operational. No pools/bodies of water are on premises. Last disaster drill was conducted on August 20, 2024. The facility has been conducting monthly fire drills.

The licensee is in the process of painting the exterior of the home and plan to complete by end of November 2024.

No deficiencies are being cited as a result of today's inspection. Technical assistance was provided.

Exit interview conducted and copy of report was provided to administrator Nora Serrano.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE: DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2024
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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