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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 297003424
Report Date: 10/17/2024
Date Signed: 10/17/2024 01:55:51 PM

Document Has Been Signed on 10/17/2024 01:55 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:RYAN'S RESIDENTIAL CAREFACILITY NUMBER:
297003424
ADMINISTRATOR/
DIRECTOR:		NOEMI RYANFACILITY TYPE:
735
ADDRESS:16858 LENA COURTTELEPHONE:
(530) 274-2541
CITY:GRASS VALLEYSTATE: CAZIP CODE:
95949
CAPACITY: 6CENSUS: 6DATE:
10/17/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:25 AM
MET WITH:Noemi Ryan, AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:10 PM
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Licensing Program Analyst (LPAs) Cassandra Mikkelson and Michael Hood arrived at the facility unannounced on 10/17/24 to conduct a Required-1 Year Inspection utilizing the inspection tool.

LPAs conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are three (3) bedrooms and two (2) bathrooms for resident use. LPAs observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition and properly maintained. Hot water temperature was observed to be 110.2 degrees F.

LPAs checked the kitchen area for the ability to prepare and store food. Care home has required two (2) day perishable and seven (7) day non-perishable food supply on site. LPAs observed the backyard and perimeter of the care home to be free of clutter and debris. LPAs observed smoke detectors to be operational in the care home. First aid kit is maintained and ready for emergency use.

LPAs observed two (2) residents' medication and observed medications being given as prescribed. LPAs reviewed six (6) resident files and six (6) staff file. Facility has a current copy of certificate of liability insurance and LPAs obtained a copy.

As a result of this visit, no deficiencies were cited per California Code of Regulations, Title 22. Exit was interview conducted and copy of report given at the conclusion of this visit.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2024
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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