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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002541
Report Date: 06/20/2023
Date Signed: 06/20/2023 04:15:57 PM

Document Has Been Signed on 06/20/2023 04:15 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:RIVER CITY RESIDENTIALFACILITY NUMBER:
455002541
ADMINISTRATOR:JOHN HOUSTONFACILITY TYPE:
735
ADDRESS:5886 LIVE OAK LANETELEPHONE:
(530) 605-0013
CITY:REDDINGSTATE: CAZIP CODE:
96001
CAPACITY: 6CENSUS: 6DATE:
06/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Lori Reed, AdministratorTIME COMPLETED:
04:25 PM
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LPA Hiratsuka conducted this unannounced annual visit. LPA toured the facility with Lori Reed, Administrator.

This facility has a fire clearance for six ambulatory only residents. The facility has four resident rooms: two shared and two private. The facility has an ample supply of perishable and nonperishable food. The common areas and bathrooms are clean. There is a pool in the backyard that is fenced.

Several topics were discussed.

No deficiencies cited.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2023
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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