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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
315920040
Report Date:
05/29/2024
Date Signed:
05/29/2024 04:29:02 PM
Document Has Been Signed on
05/29/2024 04:29 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 LIVING
FACILITY NUMBER:
315920040
ADMINISTRATOR:
JENNIFER FUSTON
FACILITY TYPE:
740
ADDRESS:
3625 BLUE OAKS DR
TELEPHONE:
(530) 718-1553
CITY:
AUBURN
STATE:
CA
ZIP CODE:
95602
CAPACITY:
65
CENSUS:
47
DATE:
05/29/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
04:00 PM
MET WITH:
Kaitlyn Sutherland, DHW
TIME COMPLETED:
04:45 PM
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On 5/29/2024 LPA Tryon visited the facility to do an interview with staff and work on a complaint that was filed on 4/19/2024 against the prior license for the facility. This complaint has nothing to do with the new/current license issued on 4/25/2024.
LPA met with the Director of Health and Wellness Kaitlyn Sutherland and explained the purpose of the visit. LPA met with and interviewed staff.
Further investigation is needed at this time.
Exit interview conducted.
SUPERVISOR'S NAME:
Troy Ordonez
TELEPHONE:
(916) 263-4832
LICENSING EVALUATOR NAME:
Todd Tryon
TELEPHONE:
(916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE:
05/29/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
05/29/2024
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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