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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317000174
Report Date: 11/06/2023
Date Signed: 11/07/2023 09:59:00 AM


Document Has Been Signed on 11/07/2023 09:59 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: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: 13DATE:
11/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Andrea DowlingTIME COMPLETED:
04:00 PM
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On 11/6/2023 LPA Tryon visited the facility to conduct an annual visit. LPA met with Andrea Dowling.

LPA toured the facility including common areas, bedrooms, kitchen, dining room, hallways. Food supplies appear adequate to meet the requirement of 2 days perishable and 7 days non-perishable. Food and menu are varied and of good quality.
Rooms are clean and appropriately furnished as per resident desire and taste. There is adequate lighting, etc. Plumbing fixtures are clean and working. Smoke/fire system is installed and checked regularly. Carbon monoxide detectors installed.
Medications are centrally stored and locked in a med cart. Appropriate logs are maintained.. Client files include required information including admission agreements, physician reports, pre-placement appraisals, care plans, medication records.
Staff files include appropriate documentation, physicals, fingerprint clearances, training, etc.
Administrator has submitted classes to obtain updated Admin. Certification.
The facility has current liability insurance.
The temperature in the facility was comfortable.
The facility is in good repair and clean overall. No safety hazards noted.
LPA reviewed the CARE Tool with staff, completed staff and resident interviews.

At this time, the facility appears to be in substantial compliance with the regulations.

Exit interview conducted.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 11/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/06/2023
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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