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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002486
Report Date: 01/03/2022
Date Signed: 01/03/2022 10:19:55 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:VETERANS HOME OF CALIFORNIA-REDDINGFACILITY NUMBER:
455002486
ADMINISTRATOR:EISZELE, PAMELAFACILITY TYPE:
740
ADDRESS:3400 KNIGHTON ROADTELEPHONE:
(530) 224-3300
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY:93CENSUS: 85DATE:
01/03/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator Pam EiszeleTIME COMPLETED:
10:40 AM
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On 01/03/2022, Jaclyn Avila, Licensing Program Analyst (LPA) conducted a case management visit to the facility for the purpose of delivering an Order to Individual of Immediate Exclusion from all facilities and the Order to Licensee/Facility of Immediate Exclusion from Facility.

Prior to initiating the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: PAPR. LPA completed the facility screening questionnaire.

LPA Avila met with the Administrator Pam Eiszele, Assisted Administrator Ron Thoreson, Kristi Mudson Standards Compliance Coordinator and explained the purpose of today's visit. Angela Metropulos, Staff Person is excluded as of this date 12/31/2021, due to her actions related to this facility.

LPA Avila handed the Order to Licensee/Facility of Immediate Exclusion from the Facility and explained that staff person Angela Metropulos cannot be allowed to work, be present and/or live in a Community Care Licensing (CCL) licensed facility or have contact with clients in any residential facility or child day care licensed by the California Department of Social Services.

Prior to arriving at the facility, LPA Avila attempted to meet with Angela Metropulos but was unable to make contact to serve the Order to Individual of Immediate Exclusion from all facilities.

A copy of this report was provided to the Administrator via e-mail.
SUPERVISOR'S NAME: Rayna L BrysonTELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Jaclyn AvilaTELEPHONE: (530) 895-4275
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2022
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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