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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002781
Report Date: 03/22/2022
Date Signed: 03/22/2022 01:02:14 PM

Document Has Been Signed on 03/22/2022 01:02 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:EMERALD RESIDENTIALFACILITY NUMBER:
455002781
ADMINISTRATOR:CULVER, REBECCAFACILITY TYPE:
735
ADDRESS:1132 GROUSE DRTELEPHONE:
(530) 200-0701
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY: 6CENSUS: 4DATE:
03/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Rebecca Culver, AdministratorTIME COMPLETED:
01:33 PM
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Licensing Program Analysts (LPAs) Misty Valencia and Shannon Dieagoruelas arrived at the facility unannounced to conduct a Required-1 Year Inspection utilizing the infection control domain. LPAs met with Rebecca Culver, Administrator explained the purpose of the visit. Prior to initiating the annual inspection, LPAs 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. LPAs ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Masks. Additionally, LPAs were screened by facility staff at the front door.

LPAs and Administrator toured facility together to ensure health and safety of residents in care. Areas toured included but are not limited to: common areas, three (3) resident bedrooms, two (2) bathrooms, kitchen, front yard. In the areas toured no immediate health, safety, or personal rights violations were observed. LPAs and the Administrator completed the infection control domain.

No deficiencies are being cited as a result of todays inspection.

Exit interview conducted and copy of report was emailed to administrator Rebecca Culver.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Misty Valencia
LICENSING EVALUATOR SIGNATURE: DATE: 03/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/22/2022
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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