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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 121372020
Report Date: 01/06/2025
Date Signed: 01/06/2025 02:12:58 PM

Document Has Been Signed on 01/06/2025 02:12 PM - 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:FRYE'S CARE HOMEFACILITY NUMBER:
121372020
ADMINISTRATOR/
DIRECTOR:
DELORES FRYEFACILITY TYPE:
740
ADDRESS:2240 FERN STREETTELEPHONE:
(707) 442-2712
CITY:EUREKASTATE: CAZIP CODE:
95503
CAPACITY: 58TOTAL ENROLLED CHILDREN: 0CENSUS: 36DATE:
01/06/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Katelyn FormbyTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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At approximately 11:30AM, Licensing Program Analyst (LPA) Chris Arnhold made an unannounced annual required inspection of this licensed senior care facility. LPA met with Assistant Manager Katelyn Formby. At approximately 11:45AM, LPA toured the building and grounds which was found to be clean and in good repair. LPA observed all walkways and exits to be unobstructed. All notices that are required to be posted have been posted and are in a highly visible area. LPA observed activity supplies for resident use. The amount of fresh and nonperishable foods is within regulation. Facility kitchen, refrigerators and freezers were clean, and food was stored properly. Toxins are stored in storage closets throughout the building. Water temperature measured within regulation throughout the facility. Fire extinguishers inspected were charged. Smoke detectors were found to be in working order. Facility has fire sprinklers throughout. Carbon Monoxide detectors were present. There was enough lighting in all common areas, resident rooms, and hallways. Medication is centrally stored and secure.
At approximately 12:25PM, LPA reviewed 5 of 36 resident records. 5 of 5 records contained current and signed admission agreements and current care plans. Medication records are thorough and contained physician's orders for each resident.
At approximately 1:00PM, LPA reviewed 6 staff records. 6 of 6 records contained documentation of completed training as required.
At approximately 1:45PM, LPA reviewed the facility emergency disaster plan with staff. Facility has a generator to supply power during an outage. The plan outlines evacuation routes, which are shown on facility sketch and has alternative meeting locations. Facility has supplies enough to operate for more than 72 hours in an emergency. Facility conducts emergency drills quarterly.

Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit:
LIC500- Personnel Report
Evidence of Liability Insurance

No citations issue during today's visit.
Bethany MoellersTELEPHONE: (707) 588-5040
Christopher ArnholdTELEPHONE: (707) 588-5084
DATE: 01/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/06/2025
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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