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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002333
Report Date: 07/17/2023
Date Signed: 11/13/2023 02:52:39 PM

Document Has Been Signed on 11/13/2023 02:52 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:PLATINUM HOMEFACILITY NUMBER:
455002333
ADMINISTRATOR:ZUMKEHR, ERICFACILITY TYPE:
735
ADDRESS:7279 PLATINUM WAYTELEPHONE:
(530) 247-0852
CITY:REDDINGSTATE: CAZIP CODE:
96001
CAPACITY: 3CENSUS: 3DATE:
07/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:03 PM
MET WITH:Administrator Cameron OlsonTIME COMPLETED:
04:00 PM
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On 07/17/2023, Licensing Program Analyst (LPA) Jaynae Boyles, and Sarah Benson arrived at the facility unannounced to conduct a 1-Year Required Annual Inspection. LPA's met with Facility Administrator, Cameron Olson to explained the purpose of the visit.

LPA Boyles, Benson and Administrator 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's observed the facility to be clean, and odor-free and each bathroom to have the necessary paper towels, trash can with lids and 20-second hand-washing poster. Facility has a 2-day perishable and a 7-day non-perishable amount of food and sharps to be locked. LPA observed (2) fire extinguishers, fire detectors, and carbon monoxide detectors.

LPA reviewed a total of three (3) resident files and no (0) staff files.

Several topics were discussed.

This annual will have to be continued, as the staff files were not made available to the LPA's to review timely. LPA will be returning at a later date to continue to annual, review files and issue citations.

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

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Jaynae Boyles
LICENSING EVALUATOR SIGNATURE: DATE: 07/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/17/2023
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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