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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002332
Report Date: 08/28/2024
Date Signed: 08/28/2024 02:05:14 PM

Document Has Been Signed on 08/28/2024 02:05 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:MDH RESIDENTIALFACILITY NUMBER:
455002332
ADMINISTRATOR/
DIRECTOR:		HEMSTED, TAMARIEFACILITY TYPE:
735
ADDRESS:4369 BOWYER BLVDTELEPHONE:
(530) 604-3055
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY: 4CENSUS: 4DATE:
08/28/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Tamarie HemstedTIME VISIT/
INSPECTION COMPLETED:
09:30 AM
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On 8/28/2024 at 9:00AM, an office meeting was conducted virtually via Microsoft Teams Meeting. The purpose of this office meeting is to discuss an incident that occurred regarding a client in the care home. Present in the meeting is Licensing Program Manager (LPM) Anthony Perez, Licensing Program Analyst (LPA) Ivan Avila, and Administrator Tamarie Hemsted.

The office meeting process was explained during this meeting.

Topics discussed at the meeting include, but are not limited to:

· Health and Safety of clients

· Assistance from Far Northern Regional Center to update Needs and Service Plan

· Coordinating with Far Northern for new placement

· Mandate reporting

· Training for staff and clients on online dating provided by Far Northern Regional Center

· Harassment with the community on social media platforms

Administrator will inform LPA on updates regarding client’s reassessments and mental health visits.

LPA will follow-up with Administrator.

Exit interview conducted. Office meeting concluded and a copy of report will be emailed. Facility Representative Signature is expected to be signed and returned to LPA by close of business, 8/28/2024

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Ivan Avila
LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2024
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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