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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002831
Report Date: 12/23/2022
Date Signed: 12/23/2022 11:16:12 AM

Document Has Been Signed on 12/23/2022 11:16 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:PEOPLE'S CARE KRANS COURTFACILITY NUMBER:
345002831
ADMINISTRATOR:BRITT, AMANDAFACILITY TYPE:
735
ADDRESS:8530 KRANS COURTTELEPHONE:
(909) 287-3557
CITY:ANTELOPESTATE: CAZIP CODE:
95843
CAPACITY: 4CENSUS: 4DATE:
12/23/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Facility Staff-DSP-Trinette Driskell TIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 12/23/2022 and met with DSP - Trinette Driskell and explained the purpose of the visit. Prior to initiating the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA completed a facility risk assessment upon arrival. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. LPA was screened by staff upon entry.

DSP told LPA that administrator Amanda Britt is out today and attending a meeting outside. DSP contact Aamanda who gave permission to DSP to complete the visit with LPA and sign the report.

Today's visit is to check the health and safety of clients in care after facility had to do Emergency Evacuation for all clients on 12/21/22 due to plumbing issues at the facility. Per administrator, plumbing issue has been completely resolved and all residents came back to facility on 12/22/22. DSP and LPA did brief tour to all bathrooms and kitchen at the facility and observed that there is no plumbing issues at this time and all faucets, toilets etc are working fine with no problem. All 4 clients were present during today's visit with care and supervision of 2 DSP.

No deficiencies were observed or cited for this visit.

Exit interview conducted with DSP and copy of the report left at the facility.




SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE: DATE: 12/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/23/2022
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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