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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317005531
Report Date: 01/30/2023
Date Signed: 01/31/2023 11:27:13 AM


Document Has Been Signed on 01/31/2023 11:27 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
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:SIERRA RIDGE SENIOR LIVINGFACILITY NUMBER:
317005531
ADMINISTRATOR:NISHA KUARFACILITY TYPE:
740
ADDRESS:3265 BLUE OAKS DRTELEPHONE:
(530) 887-8600
CITY:AUBURNSTATE: CAZIP CODE:
95602
CAPACITY:65CENSUS: 39DATE:
01/30/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Jami Koopman and Nekia XavierTIME COMPLETED:
12:00 PM
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On 1/30/2023 LPA Tryon and LPA Ayers arrived at the facility unannounced to do an annual visit using the Infection Control Domain of the CARE Tool. LPAs were screened at entrance and wore N-95 masks, as requested by the facility.

LPAs toured the facility including common areas, kitchen, food storage, dining room, resident rooms, bathrooms, hallways, laundry, storage, yard, etc. Fire extinguishers present and charged, were checked recently.

The facility appears to be in good, condition, clean, no safety hazards noted. Delayed egress exits installed at all doors.

LPA reviewed the Infection Control Domain with staff.

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: 01/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/30/2023
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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