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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002864
Report Date: 01/26/2022
Date Signed: 01/26/2022 11:21:02 AM

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:OLD RANCH VILLAFACILITY NUMBER:
345002864
ADMINISTRATOR:RONSTADT, STEVENFACILITY TYPE:
740
ADDRESS:8312 BLAYDAN CTTELEPHONE:
(831) 706-8481
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:6CENSUS: 6DATE:
01/26/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Steven Ronstadt, AdministratorTIME COMPLETED:
11:35 AM
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Licensing Program Analyst (LPA) Michael Hood met with applicant, Steven Ronstadt, to conduct a Pre- Licensing visit. This application is a change in ownership. This address is currently licensed as OLD RANCH VILLA Facility #: 342700035. The facility has a fire clearance for 6 non-ambulatory residents. Applicant holds a current administrator certificate (#6051256740 with expiration date 2/26/2023).

LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are six bedrooms and four bathrooms for resident use, along with one bedroom and one bathroom for staff. LPA 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 116 degrees F.

LPA checked the kitchen area for the ability to prepare and store food. LPA observed at least a 2-day perishable and 7-day nonperishable food supply at the facility. LPA observed cleaning products and other toxins to be locked away. LPA observed the area used for medication to be locked and inaccessible to residents. LPA observed smoke detectors and carbon monoxide detectors at the care home are operational. Fire extinguisher is ready for emergency use. LPA reviewed two resident files and two staff files.

LPA observed during visit that first aid kit was missing a manual and resident files were missing Needs and Services Plan. LPA indicated all the above observations need to be fixed and facility will send corrections to CCLD within 7 days from today's date.

Pre-licensing passed and Component III waived. Applicant has satisfied all requirements in accordance to Title 22, California Code of Regulations. Application is pending and LPA will forward findings to the Centralized Application Bureau (CAB) for final review and approval. 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: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael HoodTELEPHONE: 916-531-7341
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022
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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