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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045002777
Report Date: 07/30/2021
Date Signed: 07/30/2021 11:25:00 AM

Document Has Been Signed on 07/30/2021 11:25 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:RAVEN RESIDENTIALFACILITY NUMBER:
045002777
ADMINISTRATOR:LEAK, LAURENFACILITY TYPE:
735
ADDRESS:585 BREARCLIFFE DRIVETELEPHONE:
(530) 736-0980
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY: 4CENSUS: DATE:
07/30/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Lauran Leak, LicenseeTIME COMPLETED:
12:00 PM
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07/30/2021 10:30 AM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility to conduct a Post-Licensing visit. LPA met with Licensee Lauren Leak and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical mask, gloves. LPA asked licensee if there were any Covid 19 positive exposed or symptomatic staff or clients while at the facility, Licensee stated No. Additionally, LPA Knight was screened by Lauren Leak, Licensee.

LPA toured the facility inside and out. The inside of the facility was observed to be in good condition and repair. The facility has 4 bedrooms, 1 of which is for a non-ambulatory client. The facility has two bathrooms which are set up with soap for hand washing. LPA observed 1 dining table with 4 chairs in the dining room. The licensee has a leaf that is added to the dining table which extends the length to 6 feet and allows 2 clients to eat at the table, one at each end. When the facility has more clients the other two clients will sit in the living room using sturdy TV trays, all socially distanced, or the facility will offer staggered meal times. LPA observed 1 couch and a large easy chair in the living room.



Food storage meets Title 22 regulation requirements. Plates, utensils, pots, and pans were in place during the inspection. Dishwasher, stove, microwave were all present and working. Water temperature registered within Title 22 requirements.

The facility has one fully charged fire extinguisher which was inspected by the fire marshal on 2/22/2021. LPA observed smoke alarms and carbon monoxide detectors fully functioning.

Continued on LIC809-C

SUPERVISORS NAME: Rayna L Bryson
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE: DATE: 07/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/30/2021
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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: RAVEN RESIDENTIAL
FACILITY NUMBER: 045002777
VISIT DATE: 07/30/2021
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Bedrooms were observed to have furniture as required by Title 22 Regulations. All beds were made up with linens and bedspreads. The facility has a linen closet which contains towels and face cloths. Bathrooms were observed to be in good repair.

Storage and lighting is adequate in the home. Medications are locked up in a cabinet in the living room. Cleaning supplies and toxins are locked up in a cabinet in the kitchen under the sink. Knives are locked in the med cabinet. Washer and dryer observed in place and ready for use.

There is a locking office space where extra PPE , paper products, cleaning supplies, and extra food is stored.

The back yard has a nice shaded structure with a table, and chairs for the clients to use. The front yard has a large lawn area that extends along the side of the house.

The facility has Covid-19 preparation in place to include signs, proper cleaning protocols are in place. All staff were observed wearing masks while in the facility. The facility also has proper screening for all staff visitors and clients.

No deficiencies were cited at this visit today according to CCR Title 22, Division 6.
SUPERVISORS NAME: Rayna L Bryson
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021
LIC809 (FAS) - (06/04)
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