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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002201
Report Date: 12/13/2023
Date Signed: 12/13/2023 11:36:00 AM

Document Has Been Signed on 12/13/2023 11:36 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:ROAD RUNNER HOMEFACILITY NUMBER:
455002201
ADMINISTRATOR:MONTGOMERY, YVETTEFACILITY TYPE:
735
ADDRESS:10059 ROAD RUNNER WAYTELEPHONE:
(530) 222-1113
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY: 4CENSUS: 3DATE:
12/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:House Manager- Crystal MonismithTIME COMPLETED:
11:45 AM
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On 12/13/2023, Licensing Program Analyst (LPA) Jaynae Boyles, arrived at the facility unannounced to conduct a 1-Year Required Annual Inspection. LPA met with Facility Administrator Yvette Montgomery and House Manager Crystal Monismith and explained the purpose of the visit.

LPA Boyles, Administrator and House Manager toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, garage, backyard, and common restrooms. LPA observed the facility to be clean, in good repair and odor-free and each bathroom to have the necessary grab bars, non-skid flooring, paper towels, trash can with lids and 20-second hand-washing poster. Facility had a plethora of supplies for activities.

Facility has a 2-day perishable and a 7-day non-perishable amount of food and sharps to be locked. Hot water temperature was measured at 120 F. LPA observed three (3) fire extinguishers, fire detectors, and carbon monoxide detectors. LPA observed first aid kit which had all the requirements. LPA observed the emergency disaster plan and emergency disaster drills, which met all the requirements.

In the areas toured no immediate health, safety, or personal rights violations were observed.

LPA reviewed a total of three (3) residents' files and three (3) staff files which had all the required documents.

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.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Jaynae Boyles
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2023
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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