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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045002620
Report Date: 04/20/2023
Date Signed: 04/20/2023 10:02:34 AM


Document Has Been Signed on 04/20/2023 10:02 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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833



FACILITY NAME:INN AT THE TERRACES, THEFACILITY NUMBER:
045002620
ADMINISTRATOR:KEENE, CLIFFFACILITY TYPE:
740
ADDRESS:2950 SIERRA SUNRISE TERRACETELEPHONE:
(530) 894-5429
CITY:CHICOSTATE: CAZIP CODE:
95928
CAPACITY:99CENSUS: 84DATE:
04/20/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Wendy Anderson - Resident Services DirectorTIME COMPLETED:
10:15 AM
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04/20/2023 09:30 AM Licensing Program Analyst (LPA) Rebecca Knight made an unannounced visit to the facility and met with Resident Services Director Wendy Anderson. The purpose of this visit was to confirm that the facility had posted a notification of The Department’s intent to revoke the facility license.

Ms. Anderson stated the notice was posted in the facility near the mail boxes on 03/14/2023. LPA observed the posting during the visit and confirmed the posting contained all required elements contained in Health & Safety Code 1569.38 Posting of licensing reports; disclosure to new residents.

During the visit LPA requested a copy of the posting, and the letter that was mailed out to all residents and their responsible parties on 03/14/2023. LPA also obtained a list of telephone numbers for resident’s responsible parties.

No deficiencies cited. Exit interview conducted and a copy of the report was provided.

SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:
DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/20/2023
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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