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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455001857
Report Date: 03/06/2023
Date Signed: 03/06/2023 02:29:58 PM


Document Has Been Signed on 03/06/2023 02:29 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
CCLD Regional Office,
, CA



FACILITY NAME:SPRING HILLS ASSISTED LIVINGFACILITY NUMBER:
455001857
ADMINISTRATOR:MANACOP, CRISTETAFACILITY TYPE:
740
ADDRESS:2106 VICTOR AVENUETELEPHONE:
(530) 221-7757
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY:6CENSUS: 4DATE:
03/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Rubyann Villanueva - Direct Care StaffTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced Required 1 Year Inspection Visit utilizing the infection control domain, LPA met with staff Ruby Ann Villanueva and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols.. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical masks and gloves. Additionally LPA was screened by facility staff.

LPA Wallace and direct care staff toured facility together to ensure health and safety of residents in care. Areas toured include, but are not limited to: common areas, six (6) resident bedrooms, five (5) bathrooms, kitchen, storage areas, and back yard. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA Wallace and the administrator completed full inspection care tool and facility was found to be in substantial compliance at this time.

LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 109.2 degrees Fahrenheit in bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Fire Extinguishers were inspected on 1/9/2023 and in compliance. Smoke and carbon monoxide detectors are in compliance with fire safety. LPA observed centrally stored medications, toxins and sharp knives kept locked and inaccessible to clients. LPA reviewed two (2) client and two (2) staff files, including criminal record clearances. LPA reviewed Fingerprint clearance and associations to the facility. First aid kit was checked and is complete.

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

Exit interview conducted and copy of report was left with direct care staff.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Ruth WallaceTELEPHONE: (619) 323-4509
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2023
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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