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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045002620
Report Date: 11/30/2023
Date Signed: 11/30/2023 11:36:13 AM


Document Has Been Signed on 11/30/2023 11:36 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: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: 80DATE:
11/30/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Administrator Cliff Keene TIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Jaynae Boyles arrived unannounced to conduct a case management inspection to ensure facility is in compliance with Health and Safety Code ยง1569.38 Posting of licensing reports; disclosure to new residents following the department serving an Accusation. LPA met with Administrator, and explained purpose of inspection.

Administrator showed LPA the posted notice displayed in the lobby. LPA observed the notice to contain the required elements. Administrator confirmed a letter will be sent to residents and resident representatives on 12/1/23 and to the Ombudsman.

LPA reviewed the required training for the Administrator, it met all the requirements in the stipulation and is approved by the Department.

There are no deficiencies being cited today.

Exit interview conducted. Copy of report left with Administrator.
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Jaynae BoylesTELEPHONE: (916) 208-6251
LICENSING EVALUATOR SIGNATURE:
DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/30/2023
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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