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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317000174
Report Date: 11/14/2024
Date Signed: 11/15/2024 08:23:38 AM

Document Has Been Signed on 11/15/2024 08:23 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/
DIRECTOR:		BILL HUNTFACILITY TYPE:
740
ADDRESS:750 AUBURN RAVINE ROADTELEPHONE:
(530) 823-8339
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY: 25TOTAL ENROLLED CHILDREN: 0CENSUS: 17DATE:
11/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 11/14/2024 LPA Tryon visited the facility to conduct an annual visit. LPA met with
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..


At this time, LPA needs to stop the visit and continue at a later date due to time constraints.

Exit interview conducted.
Troy OrdonezTELEPHONE: (916) 263-4832
Todd TryonTELEPHONE: (916) 263-4700
DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2024
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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