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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045920050
Report Date: 11/07/2023
Date Signed: 11/07/2023 10:34:17 AM


Document Has Been Signed on 11/07/2023 10:34 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 2FACILITY NUMBER:
045920050
ADMINISTRATOR:CARTWRIGHT, KATHERINEFACILITY TYPE:
740
ADDRESS:5 BUDLEE CTTELEPHONE:
(530) 809-2824
CITY:CHICOSTATE: CAZIP CODE:
95928
CAPACITY:6CENSUS: 5DATE:
11/07/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator Katherine CartwrightTIME COMPLETED:
10:40 AM
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On 11/7/2023, Licensing Program Analysts (LPAs) Jaynae Boyles and Ivan Avila arrived at the facility unannounced to conduct a Pre Licensing Inspection. LPAs met with Facility Administrator, Katherine Cartwright and explained the purpose of the visit.

LPAs 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 restrooms. Water temperature measured within required the regulation requirement.

LPAs observed the facility to be clean, in good repair and odor-free. LPAs observed each bathroom to have the necessary grab bars, non-skid flooring or shower chair, paper towels, trash can with lids.

LPAs checked the kitchen area for the ability to prepare and store food. Facility has required (2) two-day perishable and (7) seven-day non-perishable food supply on hand. LPAs observed knives, cleaning products, and other toxins to be locked away and inaccessible to residents.



LPAs observed one (1) fire extinguishers, fire detectors, and carbon monoxide detectors which were last serviced in February of 2023.

In the areas toured no immediate health, safety, or personal rights violations were observed.
LPAs reviewed a total of three (3) residents' files and three (3) staff files which had all the required documentation.

Several topics were discussed.

COMP 3 will be waived as the Administrator has sufficient experience.

As a result of this visit, no deficiencies were cited per California Code of Regulations, Title 22. Exit interview conducted and copy of report given

This facility is ready to be licensed.

SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Jaynae BoylesTELEPHONE: (916) 208-6251
LICENSING EVALUATOR SIGNATURE:
DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/07/2023
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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