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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045002620
Report Date: 10/29/2022
Date Signed: 10/29/2022 02:34:46 PM


Document Has Been Signed on 10/29/2022 02:34 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
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926



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:
10/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Wendy AndersonTIME COMPLETED:
02:55 PM
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On 10/29/2022, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced to conduct a required annual. LPA met with Resident Services Director, Wendy Anderson, and explained the purpose of the visit. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols and additionally, LPA was screened per COVID-19 precautionary measures upon entering the community. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. Resident Services Director confirmed there is (1) resident on hospice services, facility has a hospice waiver of 10.

LPA and Resident Services Director toured the interior of the facility, including (1) private resident rooms, restrooms, kitchen, laundry room, medication room, library, Arts & Crafts Room, Bistro, Fitness Center, Game Room and Mammoth Theater Room and common areas. LPA observed it to be clean, in good repair and odor free. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Resident Services Director completed the infection control domain and facility was found to be in compliance at this time.

LPA observed sufficient 2+day perishable and 7+day non-perishable food. LPA observed hand sanitizers to be located throughout the facility. LPA observed fire extinguishers located on all levels of the facility, which was last serviced on 09/16/2022. LPA observed restrooms to have handwashing signs, paper towels, soap and trashcan with lid. LPA observed and obtained a copy of Administrator Certificate #6003054740 which is up to date with expiration date of 06/14/2023. At this time, LPA requested a current copy of liability insurance and LIC 610E- Emergency Disaster Plan to be emailed to LPA Yang by Friday November 4, 2022.

There were no deficiencies observed during today's inspection. Exit interview. Copy of report provided to Resident Services Director.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 10/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/29/2022
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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