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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045002997
Report Date: 09/12/2024
Date Signed: 09/12/2024 10:05:28 AM

Document Has Been Signed on 09/12/2024 10:05 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:HOPE ALZHEIMER'S AND DEMENTIA CAREFACILITY NUMBER:
045002997
ADMINISTRATOR/
DIRECTOR:		BERNHARDT, JESSICA DAWNFACILITY TYPE:
775
ADDRESS:1272 ARCH WAYTELEPHONE:
(530) 592-9083
CITY:CHICOSTATE: CAZIP CODE:
95973
CAPACITY: 6CENSUS: 6DATE:
09/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:Adminstrator- Jessica TIME VISIT/
INSPECTION COMPLETED:
10:15 AM
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On 09/12/2024, Licensing Program Analyst (LPA) Jaynae Boyles, arrived at the facility unannounced to conduct a 1-Year Required Annual Inspection. LPA met with Facility Administrator, Jessica Bernhardt and explained the purpose of the visit.

LPA Boyles and Administrator toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, bedrooms, garage, backyard, and common restrooms.

LPA observed the facility to have a plethora of supplies and space for activities.

LPA observed each bathroom to have the necessary grab bars, non-skid flooring or shower chair, paper towels, trash can with lids and 20-second hand-washing poster.

LPA observed the chemicals, knives, and medication to be locked inaccessible to residents.

LPA observed two (2) fire extinguishers, fire detectors, and carbon monoxide detectors. LPA observed a completed first aid kit ready for emergency use. LPA observed a completed emergency disaster plan.

LPA observed the facility to be clean, in good repair and odor-free. In the areas toured no immediate health, safety, or personal rights violations were observed.

LPA reviewed a total of five (5) residents' files and one (1) staff file which contained all of the required documentation.

Several topics were discussed.

No deficiencies are being cited as a result of today’s inspection.

Exit interview conducted and copy of report left at the facility.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Jaynae Boyles
LICENSING EVALUATOR SIGNATURE: DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2024
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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