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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317005531
Report Date: 02/14/2024
Date Signed: 02/15/2024 10:45:06 AM


Document Has Been Signed on 02/15/2024 10:45 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:SIERRA RIDGE SENIOR LIVINGFACILITY NUMBER:
317005531
ADMINISTRATOR:JENNIFER FUSTONFACILITY TYPE:
740
ADDRESS:3265 BLUE OAKS DRTELEPHONE:
(530) 887-8600
CITY:AUBURNSTATE: CAZIP CODE:
95602
CAPACITY:65CENSUS: 39DATE:
02/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Jennifer Fuston, Executive DirectorTIME COMPLETED:
03:30 PM
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On 2/14/2024 LPA Tryon visited the facility to conduct an annual visit. LPA met with Executive Director Jennifer Fuston.
LPA and ED toured the facility including common areas, hallways, kitchen, food supplies/coolers, dining area, offices, laundry, 4 resident rooms/bathrooms.
The facility was clean and well-furnished. The facility has recently undergone a renovation/re-decorating, and is still in the process. "Nursing-staff" station was removed in the front and converted to a resident common area. Carpets have been replaced by new, textured laminate flooring that will be much easier to keep clean and sanitary. New furniture has been supplied and the atmosphere is pleasant overall.
Rooms toured were clean and orderly, and were decorated with appropriate furnishings. Fire extinguishers were present and recently checked/charged. Fire system installed. System is checked annually by the company.

LPA reviewed the CARE Tool with Executive Director. LPA reviewed 4 of 39 client files, and 4 staff files. Files include required documents and information.

Administrator Certificate is current. LPA requested a copy of the current liability insurance and a copy of the Admin. Certificate.

At this time, the facility appears to be in substantial compliance. No deficiencies were noted. Exit interview conducted.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2024
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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