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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045920042
Report Date: 09/17/2024
Date Signed: 09/17/2024 10:10:10 AM


Document Has Been Signed on 09/17/2024 10:10 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:ALMOND BLOSSOM ASSISTED LIVING-BH 1FACILITY NUMBER:
045920042
ADMINISTRATOR:CARTWRIGHT, KATHERINEFACILITY TYPE:
740
ADDRESS:1 BUDLEE CTTELEPHONE:
(530) 809-2408
CITY:CHICOSTATE: CAZIP CODE:
95928
CAPACITY:6CENSUS: 6DATE:
09/17/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:05 AM
MET WITH:Administrator- Katherine CartwrightTIME COMPLETED:
10:15 AM
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On 09/17/2024, Licensing Program Analyst (LPA) Jaynae Boyles, arrived at the facility unannounced to conduct a 1-Year Required Annual Inspection. LPA met with Facility Administrator, Katherine Cartwright 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, resident bedrooms, garage, backyard, and common restroom.

LPA observed the resident bedrooms to have all of the required furnishings, working lights/fans and windows with screens. LPA observed the bathroom to have the necessary grab bars, non-skid flooring or shower chair, paper towels, and trash can with lids.

Facility has a 2-day perishable and a 7-day non-perishable amount of food. LPA observed the menu and activities calendar to be posted for residents. Hot water temperature was measured within range.

LPA observed two (2) fire extinguishers, fire detectors, and carbon monoxide detectors. LPA observered a completed emergency disaster plan. LPA observed a complete emergency disaster plan ready for emergency use. LPA observed medication, chemicals and knifes locked inaccessible to residents.

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 six (6) residents' files and four (4) staff files 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.

SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Jaynae BoylesTELEPHONE: (916) 208-6251
LICENSING EVALUATOR SIGNATURE:
DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/17/2024
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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