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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002927
Report Date: 09/10/2024
Date Signed: 09/10/2024 02:13:36 PM

Document Has Been Signed on 09/10/2024 02:13 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ASPEN RIDGE COMMUNITIES LLCFACILITY NUMBER:
345002927
ADMINISTRATOR/
DIRECTOR:		VINSON, DEONTEEFACILITY TYPE:
735
ADDRESS:6241 GILMAN WAYTELEPHONE:
(916) 450-9206
CITY:NORTH HIGHLANDSSTATE: CAZIP CODE:
95660
CAPACITY: 6CENSUS: 6DATE:
09/10/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Administrator,Deontee VinsonTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
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On 09/10/24, Licensing Program Analyst (LPA) Talwinder Bains made an unannounced visit to conduct facilities required annual inspection. LPA met with Administrator, Deontee Vinson and explained the purpose of today's visit.

LPA and administrator completed the inspection tool questionnaire with no issues.

LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, and kitchen. Bathrooms and bedrooms were clean and in good repair. There is a locked storage for medications and toxins. Food supply is adequate for 2-day perishable and 7-day nonperishable. Smoke alarms were in good working order. Fire extinguisher was maintained. LPA observed an adequate amount of linens. Hot water temperature measured at 108 degrees F. Washer and dryer was present and working.

LPA reviewed two (2) residents records and two (2) staff records. A review of staff records indicates that all facility staff have received criminal record clearances and/or are associated to this facility. Facility is conducted staff training as required.

Deficiencies were observed and cited per Title 22, CCR Regulations as listed on LIC 809-D. Civil penalties shall be assessed if facility does not comply with POC requirements which were issued today.



Exit interview conducted. Copy of this report and appeal rights were provided.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2024
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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Document Has Been Signed on 09/10/2024 02:13 PM - It Cannot Be Edited


Created By: Talwinder Bains On 09/10/2024 at 02:03 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ASPEN RIDGE COMMUNITIES LLC
FACILITY NUMBER: 345002927

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80070(b)
Client Records
(b) Each record must contain information including, but not limited to, the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on staff interview and record review ,LPA found out that residents (R1,R2) files were missing required documents , LIC627C,LIC601,LIC613, LIC621 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/25/2024
Plan of Correction
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Administrator shall ensure to complete all required documents per this Regulations in all residents files and send proof to Department by POC date-09/25/24.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Laura Munoz
LICENSING EVALUATOR NAME:Talwinder Bains
LICENSING EVALUATOR SIGNATURE:
DATE: 09/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/10/2024


LIC809 (FAS) - (06/04)
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