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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455000113
Report Date: 10/11/2023
Date Signed: 10/11/2023 11:54:39 AM

Document Has Been Signed on 10/11/2023 11:54 AM - 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:SHEPARD COURTFACILITY NUMBER:
455000113
ADMINISTRATOR:CARLEY, LANAFACILITY TYPE:
735
ADDRESS:1000 SHEPARD COURTTELEPHONE:
(530) 222-0765
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY: 6CENSUS: DATE:
10/11/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Lana CarleyTIME COMPLETED:
12:00 PM
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On October 11, 2023, an in-person informal meeting was held in the Chico Regional office. The purpose of this meeting was to discuss the deficiencies that were issued on October 04, 2023, and to produce an acceptable plan to bring the facility into compliance. Present in the meeting was Licensing Program Manager (LPM) Lauren Crocker, Licensing Program Analyst (LPA) Ivan Avila and Licensee/Administrator, Lana Carley.

The following topics were covered during today's meeting:


· The requirement of staff supervision at the facility at all times
· Residents left unattended
· Administrator recertification
· Allow the Department to inspect the entire facility including all staff rooms
· Maintenance and operation of the facility’s physical plant


Licensee agreed to do the following to achieve continued and substantial compliance:
· The Licensee will invest in a signal system to alert staff 24 hours a day.
· The Licensee will interview a maintenance staff to help repair the facility’s physical plant.
· The Licensee will allow the Department to inspect the entire facility including all staff rooms.
· The Licensee will hire an Administrator to oversee the facility while the current Administrator is recertified.

An exit interview was conducted and a copy of this report was provided.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Ivan Avila
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2023
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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