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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455001248
Report Date: 03/28/2024
Date Signed: 03/28/2024 01:03:39 PM


Document Has Been Signed on 03/28/2024 01:03 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:WILLOW SPRINGS ALZHEIMER'S SPECIAL CARE CTR.FACILITY NUMBER:
455001248
ADMINISTRATOR:GOSTAS, DARIENFACILITY TYPE:
740
ADDRESS:191 CHURN CREEK ROADTELEPHONE:
(530) 242-0654
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY:56CENSUS: 46DATE:
03/28/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator- Patricia Clark TIME COMPLETED:
01:25 PM
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On 03/28/2024, Licensing Program Analyst (LPA) Jaynae Boyles, arrived at the facility unannounced to conduct a 1-Year Required Annual Inspection. LPA met with Facility Administrator, Patricia Clark 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: common areas for dinning and activities, resident bedrooms, common restrooms and shower rooms, and the courtyard. 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.

LPA observed each bathroom to have the necessary grab bars, non-skid flooring or shower chair, paper towels, trash can with lids and 20-second hand-washing poster. LPA observed each resident bedroom to have the required furnishings, window screens and working lights. LPA observed calendar for monthly activities at the facility, and a daily posting of activities to help engage the residents. The facility has a plethora of supplies to conduct the planned activities. Facility has a 2-day perishable and a 7-day non-perishable amount of food. LPA observed the kitchen to be clean and well stocked with a variety of food for residents. LPA observed clear postings for residents with restricted diets.

LPA observed locked closets which contained toxic chemical storage. The door to the laundry room is locked. LPA observed the medication to be locked and inaccessible to residents.

LPA observed several fire extinguishers, fire detectors, and carbon monoxide detectors throughout the facility which were last services in July of 2023. LPA observed first aid kit to be complete and ready for emergency use.

LPA reviewed a total of six (6) residents' files and six (6) staff files which contained all of the required documentation.

Several topics were discussed.

No deficiencies are being cited as a result of today’s inspection.

Exit interview conducted and copy of report left at the facility.

SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Jaynae BoylesTELEPHONE: (916) 208-6251
LICENSING EVALUATOR SIGNATURE:
DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/28/2024
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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