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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045002620
Report Date: 12/16/2024
Date Signed: 12/16/2024 09:43:54 AM

Document Has Been Signed on 12/16/2024 09:43 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:WESTMONT OF CHICO-THE INNFACILITY NUMBER:
045002620
ADMINISTRATOR/
DIRECTOR:		KEENE, CLIFFFACILITY TYPE:
740
ADDRESS:2950 SIERRA SUNRISE TERRACETELEPHONE:
(530) 894-5429
CITY:CHICOSTATE: CAZIP CODE:
95928
CAPACITY: 99TOTAL ENROLLED CHILDREN: 0CENSUS: 82DATE:
12/16/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Administrator, Cliff KeeneTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
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On December 16, 2024 at approximately 08:30 AM, Licensing Program Analyst (LPA) Farhaan Sarangi arrived unannounced at Westmont of Chico-The Inn to conduct a Case Management-Legal/Non-Compliance Inspection in accordance with the Stipulation and Order effective 11/03/2023-11/03/2025. A copy of the Stipulation and Order is posted in a conspicuous place and is available for review upon request. LPA met with the Administrator, Cliff Keene and was granted access into the facility.

During the Case Management-Legal/Non-Compliance Inspection, LPA toured the facility with the Administrator. LPA found the facility to be clean with all exits free from obstruction. LPA toured the kitchen and found sufficient perishable and non-perishable foods. LPA observed a Special Diets menu board reflecting names of residents. LPA reviewed the following stipulations of the order:

1. Staff shall be sufficient in number, qualifications and competency and shall provide additional back up staff to provide the services necessary to meet residents’ needs.
· During inspection, LPA observed LIC 500 and staff schedule and found staff to be sufficient in number. LPA observed training that was conducted from November which was found to be appropriate and sufficient.

2. Facility shall inform all current and prospective residents and/or responsible parties of the facility’s probationary license by providing to the residents/residents’ responsible party a copy of the stipulation.
· LPA observed notification of the stipulation within the resident files that they or their responsible party was notified of the stipulation. LPA observed notification of the stipulation for new residents in the admissions agreement.

3. Facility shall ensure that each resident is able to receive three nutritionally well-balanced meals which within 30 days of the effective date of the stipulation shall incorporate the policy of maintaining a Daily Resident Meal Check List into the plan of operations.
· LPA observed Daily Resident Meal Check list for the month of December which is sufficient in ensuring that residents are receiving meals and the staff are checking to ensure that residents are receiving meals if they choose. The Daily Resident Meal Check List is in the plan of operations, as required by the stipulation. (Report continued on LIC 809C)
Lauren CrockerTELEPHONE: (916) 202-0832
Farhaan SarangiTELEPHONE: (916) 307-0474
DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: WESTMONT OF CHICO-THE INN
FACILITY NUMBER: 045002620
VISIT DATE: 12/16/2024
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4. Facility shall submit a written summary of hiring and training practices, including job descriptions to the licensing agency.
· LPA has observed hiring and training practices, including job descriptions in the Plan of Operation.

5. Facility staff shall submit any unusual incident reports to the licensing agency by the next working day and a written report to be submitted to the licensing agency within seven days following the date of the incident.
· LPA has observed that the facility has been reporting incidents timely and submitting the required information to the licensing agency appropriately.

No deficiencies were observed or cited during today's Case Management-Legal/Non-Compliance Inspection. Exit interview conducted and copy of report was signed and given to the Administrator.

SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 202-0832
LICENSING EVALUATOR NAME: Farhaan SarangiTELEPHONE: (916) 307-0474
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
LIC809 (FAS) - (06/04)
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