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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 097004069
Report Date: 01/26/2022
Date Signed: 01/28/2022 08:25:33 AM

Document Has Been Signed on 01/28/2022 08:25 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:REEDER HOMEFACILITY NUMBER:
097004069
ADMINISTRATOR:REEDER, JOELWELLAFACILITY TYPE:
735
ADDRESS:3540 SYLVAN LANETELEPHONE:
(530) 622-4320
CITY:PLACERVILLESTATE: CAZIP CODE:
95667
CAPACITY: 8CENSUS: 8DATE:
01/26/2022
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Joelwella ReederTIME COMPLETED:
12:30 PM
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Unannounced annual visit utilizing the infection control domain was performed by LPA Michael Smith. Contact with Joelwella Reeder.

A review of staff records on 1/26/22 indicates that all facility staff and other individuals who require caregiver background checks have received criminal record clearances.

As a result of this visit, there were no deficiencies and no technical advisories were issued.

Exit interview conducted.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Michael Smith
LICENSING EVALUATOR SIGNATURE: DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2022
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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