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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002333
Report Date: 07/27/2023
Date Signed: 07/27/2023 12:00:52 PM

Document Has Been Signed on 07/27/2023 12:00 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:
07/27/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Cameron OlsonTIME COMPLETED:
12:10 PM
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LPAs Hiratsuka and Boyles conducted this unannounced plan of correction visit (POC).

This visit is in response to citation issued on 06/21/2023. Today, LPA spoke with Administrator Cameron Olsen in person and IPS Applied Behavior Analyst Nate Dabbs via phone. The facility was cited because a resident did not have a proper bed for a time and the licensee did not request a exception to the regulation. Today, LPA received a written plan of correction stating the licensee's outline on how they shall ensure if there is anything that looks like it is going to take a long time to be repaired or replaced, that they shall communicate to Community Care Licensing Division.

Citation 85088(c)(1) Fixtures, Furniture, Equipment and Supplies, has been cleared.

No deficiencies cited.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE: DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/27/2023
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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