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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
045002628
Report Date:
02/21/2024
Date Signed:
02/21/2024 01:55:26 PM
Document Has Been Signed on
02/21/2024 01:55 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
SACRAMENTO NORTH ASC
,
9835 GOETHE ROAD, SUITE 100
SACRAMENTO
,
CA
95827
FACILITY NAME:
MOUNTAIN MEADOW LODGE
FACILITY NUMBER:
045002628
ADMINISTRATOR:
KEENE, CLIFF
FACILITY TYPE:
740
ADDRESS:
585 BILLE RD
TELEPHONE:
(530) 872-9002
CITY:
PARADISE
STATE:
CA
ZIP CODE:
95969
CAPACITY:
17
CENSUS:
0
DATE:
02/21/2024
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
01:45 PM
MET WITH:
Administrator- Cliff Keene
TIME COMPLETED:
02:00 PM
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On 2/21/2024 Licensing Program Analyst (LPA) Jaynae Boyles arrived unannounced to conduct a Required-1 Year Inspection. LPA met with licensee Cliff Keene at Inn At The Terraces (2950 SIERRA SUNRISE TERRACE Chico CA 95928) and explained the purpose of the visit.
This facility was destroyed as a result of the 2018 Camp Fire and there are no residents in care. The licensee wishes to maintain the license in the event the facility is rebuilt.
No deficiencies are being cited as a result of today’s inspection.
Exit interview conducted and copy of report was provided to licensee Cliff Keene.
SUPERVISOR'S NAME:
Lauren Crocker
TELEPHONE:
(916) 261-4966
LICENSING EVALUATOR NAME:
Jaynae Boyles
TELEPHONE:
(916) 208-6251
LICENSING EVALUATOR SIGNATURE:
DATE:
02/21/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
02/21/2024
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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