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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045002620
Report Date: 10/26/2023
Date Signed: 10/26/2023 04:10:53 PM


Document Has Been Signed on 10/26/2023 04:10 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:INN AT THE TERRACES, THEFACILITY NUMBER:
045002620
ADMINISTRATOR:KEENE, CLIFFFACILITY TYPE:
740
ADDRESS:2950 SIERRA SUNRISE TERRACETELEPHONE:
(530) 894-5429
CITY:CHICOSTATE: CAZIP CODE:
95928
CAPACITY:99CENSUS: 82DATE:
10/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Administrator Cliff Keene TIME COMPLETED:
04:20 PM
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On 10/26/2023 Licensing Program Analyst (LPA) Jaynae Boyles arrived unannounced to conduct a required annual inspections. LPA met with Administrator Cliff Keene and explained the purpose of the visit.

LPA Boyles and Administrator toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: interior of the facility, including (10) private resident rooms, restrooms, kitchen, library, Arts & Crafts Room, Bistro, Fitness Center, Game Room and Mammoth Theater Room and common areas.

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, and trash can.



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 cleaning products and other toxins to be locked away and inaccessible to residents.

LPA observed smoke detectors and carbon monoxide detector. LPA observed fire extinguishers located on all levels of the facility, which were last serviced on 09/18/2023. LPA observed hand sanitizers to be located throughout the facility.
LPA reviewed (5) resident files and also reviewed (5) staff files.
LPA observed the facility to be clean, in good repair and odor free. In the areas toured no immediate health, safety, or personal rights violations were observed. 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: 10/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2023
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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