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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455001602
Report Date: 06/21/2023
Date Signed: 06/21/2023 04:19:06 PM

Document Has Been Signed on 06/21/2023 04:19 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:RIVERVIEW DRIVE RESIDENCEFACILITY NUMBER:
455001602
ADMINISTRATOR:STEELE, TRISHAFACILITY TYPE:
735
ADDRESS:3963 RIVERVIEW DRIVETELEPHONE:
(530) 244-1516
CITY:REDDINGSTATE: CAZIP CODE:
96001
CAPACITY: 6CENSUS: 4DATE:
06/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Trisha SteeleTIME COMPLETED:
04:30 PM
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LPA Hiratsuka, conducted this unannounced annual visit. LPA toured the facility Administrator Trisha Steele.

This facility has four private resident rooms and one staff area. There is an office to the left of the main entrance. All common areas and resident rooms were toured and no health and safety issues were observed. The backyard was inspected and is free of hazards. Two resident files and two staff files were reviewed.

Several topics were discussed.

No deficiencies cited.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2023
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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