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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002550
Report Date: 09/20/2021
Date Signed: 09/20/2021 11:55:51 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:SERENITY GARDENSFACILITY NUMBER:
455002550
ADMINISTRATOR:CAIN, BETTYFACILITY TYPE:
740
ADDRESS:1233 WILLIS STREETTELEPHONE:
(530) 605-4033
CITY:REDDINGSTATE: CAZIP CODE:
96001
CAPACITY:30CENSUS: 26DATE:
09/20/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:DESIREE WRIGHTTIME COMPLETED:
12:10 PM
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Donna Gurriere, Licensing Program Analyst (LPA) arrived at the facility unannounced to conduct a case management visit regarding an incident. Met with Desiree Wright, Administrator.

LPA Gurriere completed the required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID 19 infection to affirm no COVID-19 related symptoms. The administrator was contacted to complete a facility risk assessment. LPA Gurriere ensured that hand sanitizer was applied before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA Gurriere was screened by administrator upon entering the facility.

On 09/07/21 it was reported that a resident (Resident 1) left the facility. The resident was later found two blocks away. The administrator was able to meet with the police and bring the resident back to the facility. Currently, the facility is monitoring the resident with 15 minute checks, keeping him in the common area and giving the resident an identification badge in case he were to slip out of the facility again.

An exit interview was conducted, and a copy of the report was given to the administrator. No deficiencies cited.
SUPERVISOR'S NAME: Rayna L BrysonTELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Donna GurriereTELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2021
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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