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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317005531
Report Date: 02/10/2022
Date Signed: 02/10/2022 12:27:05 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:SIERRA RIDGE SENIOR LIVINGFACILITY NUMBER:
317005531
ADMINISTRATOR:JOE DUNHAMFACILITY TYPE:
740
ADDRESS:3265 BLUE OAKS DRTELEPHONE:
(530) 887-8600
CITY:AUBURNSTATE: CAZIP CODE:
95602
CAPACITY:65CENSUS: DATE:
02/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Joe Dunham, Executive Director; Jami Koopman, Resident Care CoordinatorTIME COMPLETED:
12:30 PM
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On 2/10/2022 LPA visited the facility and met with Executive Director Joe Dunham and Resident Care Coordinator Jami Koopman to perform an annual visit using the Infection Control Domain. Prior to the visit, LPA did a self-screening by taking temperature and reviewing possible symptoms. LPA wore an N-95 mask and used hand sanitizer.

LPA toured the facility with Mr. Dunham including common areas, kitchen, dining room, bedrooms, bathrooms, hallways, etc.

LPA reviewed the infection control domain with the Administrator and Resident Care Coordinator.

The facility has completed N-95 Fit testing with the employees.

The facility appears to be in substantial compliance at this time.

Exit interview conducted
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 208-7709
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2022
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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