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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 126803830
Report Date: 10/30/2023
Date Signed: 10/30/2023 02:06:29 PM


Document Has Been Signed on 10/30/2023 02:06 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:SEQUOIA SPRINGS SENIOR LIVING COMMUNITYFACILITY NUMBER:
126803830
ADMINISTRATOR:PAMELA CHAPMANFACILITY TYPE:
740
ADDRESS:2401 REDWOOD WAYTELEPHONE:
(541) 840-4035
CITY:FORTUNASTATE: CAZIP CODE:
95540
CAPACITY:92CENSUS: 62DATE:
10/30/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Charmin BaileyTIME COMPLETED:
02:15 PM
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At approximately 10:45AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to conduct a Health and Safety inspection to ensure facility is staffed appropriately, staff are being paid, utilities are all functioning and food is plentiful. The Department received information that the Licensee was possibly experiencing some financial hardships. The purpose of today's inspection is to obtain additional information and confirm there are no immediate health and safety concerns. LPA met with Executive Director Charmin Bailey, toured the facility and reviewed records. LPA observed work being done on the earthquake damaged areas of the facility. LPA was informed completion of the project should be in the next few weeks. LPA observed lights on throughout the facility. LPA toured the kitchen and food storage areas. LPA observed the facility has the required amounts of food and the food is stored properly. LPA observed the exhaust fan above the stove was not operational. LPA was told the fan stopped working after is was serviced and the repair company will be coming to correct the issue promptly. LPA interviewed staff and learned there have been no issues with paychecks. LPA did not observe any immediate Health and Safety concerns during this visit.

An informal office meeting will be scheduled with the management company to discuss further.

No citations issued during this visit.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher ArnholdTELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:
DATE: 10/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/30/2023
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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