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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317000174
Report Date: 11/18/2024
Date Signed: 11/18/2024 01:35:55 PM

Document Has Been Signed on 11/18/2024 01:35 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: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:
11/18/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Kristie FainTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On 11/18/2024 LPA Tryon returned to the facility to complete the annual visit process, as we had run out of time at the previous visit on 11/14/2024.
LPA again met with Kristie Fain.
We completed the remainder of the CARE Tool. LPA had done a facility tour on the previous visit. LPA found the facility to be in substantial compliance with the regulations. Facility is clean, nicely furnished and comfortable. Residents were eating lunch during the second visit.
Smoke detectors and carbon monoxide detectors installed and functioning. Fire extinguishers charged. Resident rooms are clean and nicely set up, plumbing fixtures clean and functioning.
No hazards noted throughout the facility.

LPA reviewed 3 resident files of 17; and 3 staff files. Files contain required information.

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

No deficiencies were cited at this visit.

Exit interview conducted.
Troy OrdonezTELEPHONE: (916) 263-4832
Todd TryonTELEPHONE: (916) 263-4700
DATE: 11/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2024
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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