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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315920040
Report Date: 04/12/2024
Date Signed: 04/12/2024 04:52:09 PM


Document Has Been Signed on 04/12/2024 04:52 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:SIERRA RIDGE SENIOR LIVINGFACILITY NUMBER:
315920040
ADMINISTRATOR:JENNIFER FUSTONFACILITY TYPE:
740
ADDRESS:3625 BLUE OAKS DRTELEPHONE:
(530) 718-1553
CITY:AUBURNSTATE: CAZIP CODE:
95602
CAPACITY:65CENSUS: 46DATE:
04/12/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Jennifer Fuston, Excecutive DirectorTIME COMPLETED:
03:30 PM
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On April 12, 2024 LPA Tryon visited the facility unannounced to perform a pre-licensing visit related to a new application for Change of Ownership. Visit was unannounced due to current residents in care.
LPA met with Executive Director Jennifer Fuston.

LPA toured the facility with Ms. Fuston including common areas, resident rooms, bathrooms, kitchen/food storage, dining room, activity rooms, hallways, laundry, etc. The facility has just been completely re-decorated throughout the interior and is clean and in "brand-new" condition. Common areas, sitting areas are nicely furnished with new furniture and fixtures. Rooms are clean and include appropriate furniture as per Title 22 Regulations.

Activity areas are furnished appropriately and the facility has materials and equipment for activities.
The facility keeps individual files on each resident with appropriate documents and forms available. There are also staff files for each staff member, records of training, criminal record clearance, experience, medical exams, etc.

Facility has appropriate postings such as Resident Rights, agencies to call with issues/complaints, etc.

LPA reviewed the CARE Tool with Ms. Fuston.

The facility appears to be in compliance with regulations at this time.

LPA has waived the requirement for Orientation Component III as the Administrator has many years of experience as an Administrator and working in the facility and is familiar with regulations, policies, procedures, etc.

At this time the facility appears to be in substantial compliance.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 04/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/08/2024
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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