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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 297003424
Report Date: 08/28/2023
Date Signed: 08/28/2023 11:18:54 AM

Document Has Been Signed on 08/28/2023 11:18 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:RYAN'S RESIDENTIAL CAREFACILITY NUMBER:
297003424
ADMINISTRATOR:NOEMI RYANFACILITY TYPE:
735
ADDRESS:16858 LENA COURTTELEPHONE:
(530) 274-2541
CITY:GRASS VALLEYSTATE: CAZIP CODE:
95949
CAPACITY: 6CENSUS: 6DATE:
08/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Noemi RyanTIME COMPLETED:
11:45 AM
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Licensing Program Analysts (LPAs) Melissa Parks and Sarah Benson arrived on Monday August 28, 2023 to conduct the unannounced annual inspection.

During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPAs reviewed client (6) and staff (2) files. All resident files contained the required paperwork. All staff files contained the required paperwork and training.

LPA Parks and Benson and Administrator Noemi toured the facility together to ensure the health and safety of clients in care. The areas toured included bedrooms, kitchen, bathroom, garage and backyard. Water temperatures in the kitchen and bathroom were within the required range of temperature. Facility has PPE on site. In the areas toured, there were no health or safety violations observed.

No deficiencies cited. Exit interview conducted. A copy of this report was left at the facility.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2023
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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