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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317000174
Report Date: 11/05/2021
Date Signed: 11/05/2021 03:22:01 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:AUBURN RAVINE TERRACEFACILITY NUMBER:
317000174
ADMINISTRATOR:BILL HUNTFACILITY TYPE:
740
ADDRESS:750 AUBURN RAVINE ROADTELEPHONE:
(530) 823-8339
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY:25CENSUS: 16DATE:
11/05/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Andrea Dowling, Bill Hunt, AdministratorTIME COMPLETED:
03:00 PM
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LPA Tryon arrived at the facility on 11/5/21 to perform an annual visit using the Infection Control Domain. Prior to the visit, LPA had checked with the facility to ensure they do not have any COVID Positive Residents or staff. LPA did a self-screening by taking temperature and reviewing possible symptoms. LPA wore a surgical mask and used hand sanitizer. LPA met with Assisted Living Director Andrea Dowling.
LPA toured the facility including common areas,dining room, bedrooms, bathrooms, hallways.

LPA reviewed the infection control domain with Ms. Dowling. LPA requested a copy of most recent liability insurance, and current staff schedule.

The facility has completed FIT testing for staff for N-95 masks. The facility has a kit to do future fittings.

The facility appears to be in substantial compliance at this time.

Exit interview conducted
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 208-7709
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021
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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