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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002764
Report Date: 07/21/2020
Date Signed: 07/21/2020 11:12:15 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 COHASETT RD., STE. 170
CHICO, CA 95926
FACILITY NAME:SAINT LORENZ ASSISTED LIVINGFACILITY NUMBER:
455002764
ADMINISTRATOR:BIRD, JAMESFACILITY TYPE:
740
ADDRESS:740 LAKE BLVDTELEPHONE:
(650) 632-5300
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY:17CENSUS: DATE:
07/21/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:James Bird, Licensee/AdministratorTIME COMPLETED:
11:00 AM
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07/21/2020 9:00 AM Licensing Program Analyst (LPA) Rebecca Knight met with new licensee/administrator James Bird and current administrator Deborah Memeo to conduct a Pre- Licensing visit. This meeting was conducted via Face Time due to COVID-19 restrictions. This facility has a fire clearance for a capacity 17 residents: 14 non-ambulatory, and 3 bedridden.

LPA inspected physical plant including but not limited to the kitchen, bedrooms, bathrooms, activities areas and dining room areas. The facility has 17 bedrooms which are single occupied rooms. All residents share jack and jill bathrooms.The facility has a locked medication cart. The facility was clean, and in good repair. Cleaning supplies are locked in a kitchen cabinet and closets and in the locked laundry room. The facility has a kitchen, dining room, a common area, and a locking office. The facility also has a first aid kit and a telephone for residents to use. Night lights are maintained in hallways and passages. Grab bars are provided for each toilet, bathtub and shower used by residents. LPA observed sufficient furniture and lighting throughout the facility. There are sufficient sheets, pillow cases, mattress pads and blankets in good repair for each resident. There is a large patio area with shaded structures. Facility has a large fence which surrounds it.

The facility has a signal system that meets specified requirements. Fire extinguishers and smoke detectors are current and in compliance with fire safety. Carbon dioxide monitor present. Last Fire drill was conducted on May 26, 2020.

Continued on LIC809-C

SUPERVISOR'S NAME: Rayna L BrysonTELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 895-4356
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2020
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASETT RD., STE. 170
CHICO, CA 95926
FACILITY NAME: SAINT LORENZ ASSISTED LIVING
FACILITY NUMBER: 455002764
VISIT DATE: 07/21/2020
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The daily diet appears to be of the quality and quantity to meet the residents’ needs. There is at least a one week supply of nonperishable, and 2 day supply of perishable foods. Perishable foods are stored appropriately.

Component III was conducted with applicant licensee / administrator.



Based on today's inspection, the pre-licensing is complete and this facility has no deficiencies. Applicant has satisfied all requirements in accordance to per Title 22, California Code of Regulations. CAB will be notified accordingly.

Exit Interview conducted and copy of the report will be emailed to Licensee/Administrator James Bird. Mr. Bird agrees to sign, scan, and email the signed report back to LPA Knight by the close of business today 7/212020.
SUPERVISOR'S NAME: Rayna L BrysonTELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 895-4356
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2020
LIC809 (FAS) - (06/04)
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