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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002854
Report Date: 03/03/2022
Date Signed: 03/03/2022 12:55:12 PM


Document Has Been Signed on 03/03/2022 12:55 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:ALMOND GROVE ASSISTED LIVINGFACILITY NUMBER:
345002854
ADMINISTRATOR:PRICE, DARRELLFACILITY TYPE:
740
ADDRESS:6135 ALMOND AVENUETELEPHONE:
(916) 988-7506
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY:78CENSUS: 46DATE:
03/03/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Darrel Price, AdministratorTIME COMPLETED:
01:15 PM
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Licensing Program Analysts (LPAs) Michael Hood and Talwinder Bains met with applicant, Darrel Price, to conduct a Pre- Licensing visit. This application is a change in ownership. This address is currently licensed as ALMOND AVENUE RESIDENCE CLUB Facility #: 347001329. The facility has a fire clearance for seventy-five (75) non-ambulatory residents and three (3) bedridden residents. Applicant holds a current administrator certificate (#6050752740 with expiration date 12/13/2022).

LPAs conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are forty (40) bedrooms and forty (40) bathrooms for resident use. LPAs observed facility to be properly furnished, including appropriate bedding and lighting in bedrooms. Bathrooms were in sanitary condition and properly maintained. Hot water temperature was observed to be 114 degrees F. LPAs checked the kitchen area for the ability to prepare and store food. LPAs observed at least a 2-day perishable and 7-day nonperishable food supply at the facility. LPAs observed cleaning products and other toxins to be locked away. LPAs observed the area used for medication to be locked and inaccessible to residents. LPAs observed smoke detectors and carbon monoxide detectors at the care home are operational. Fire extinguishers are ready for emergency use. LPAs reviewed five (5) resident files and five (5) staff files.

LPAs observed during visit that one (1) fire extinguisher needs to be serviced, sensor on one (1) door was not operational, debris and tools were in courtyard area, files for staff and resident were missing items, and sinks were missing hand washing signs and covered trashes. LPAs indicated all the above observations need to be fixed and facility will send corrections to CCLD within 7 days from today's date.

Component III was completed. Application is pending and LPAs will forward findings to the Centralized Application Bureau (CAB) for final review and approval once requested items have been received. CAB will further contact applicant on final status of application. A copy of this report was provided to the facility. Exit interview conducted.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder BainsTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 03/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/03/2022
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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