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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045002441
Report Date: 10/24/2023
Date Signed: 10/24/2023 01:34:22 PM


Document Has Been Signed on 10/24/2023 01:34 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:AMBER GROVE PLACEFACILITY NUMBER:
045002441
ADMINISTRATOR:REITZ, BRENDAFACILITY TYPE:
740
ADDRESS:3049 ESPLANADETELEPHONE:
(530) 826-3226
CITY:CHICOSTATE: CAZIP CODE:
95973
CAPACITY:70CENSUS: 62DATE:
10/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Executive Director- Brenda ReitzTIME COMPLETED:
01:40 PM
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On 10/24/2023, Licensing Program Analyst (LPA) Jaynae Boyles, arrived at the facility unannounced to conduct a 1-Year Required Annual Inspection. LPA met with Exclusive Director, Brenda Reitz, and explained the purpose of the visit.

LPA conducted an inspection of the facility to ensure compliance with Title 22 regulations. LPA observed the facility to be clean, in good repair and odor-free. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition, properly maintained, and the hot water temperature was observed to be 115 degrees F. Each bathroom to have the necessary grab bars, non-skid flooring or shower chair, paper towels, trash can with lids.



LPA checked the kitchen area for the ability to prepare and store food. Facility has required (2) two-day perishable and (7) seven-day non-perishable food supply on hand. LPA observed knives, cleaning products and other toxins to be locked away and inaccessible to residents.

LPA observed the outdoor area and perimeter of the facility to be free of clutter and debris and there appeared to be no potential safety hazards to the residents in care. Smoke detectors and carbon monoxide detector are operational. Fire extinguisher and first aid kit are maintained and ready for emergency use.

LPA checked medication storage and found medication to be locked away and inaccessible to the residents.

LPA reviewed (5) resident files and also reviewed six (6) staff files.

As a result of this visit, no deficiencies were cited per California Code of Regulations, Title 22. Exit interview conducted and copy of report given at the conclusion of this visit.

SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Jaynae BoylesTELEPHONE: (916) 917-3040
LICENSING EVALUATOR SIGNATURE:
DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/24/2023
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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