455002787-4-20-2023-59-AS-KHIA-CR3V8C-20230420161232

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 455002787
Report Date: 04/20/2023
Date Signed: 04/20/2023 04:12:36 PM

Document Has Been Signed on 04/20/2023 04:12 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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME:	SIERRA OAKS OF REDDING		FACILITY NUMBER:	455002787
ADMINISTRATOR:	BOBAN, KRISTINE		FACILITY TYPE:	740
ADDRESS:	1520 COLLYER DR.		TELEPHONE:	(530) 241-5100
CITY:	REDDING	STATE: CA	ZIP CODE:	96003
CAPACITY:	113	CENSUS: 82	DATE:	04/20/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Kristine Boban and Susan Mosby		TIME COMPLETED:	04:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts Kerry Hiratsuka, and Sarah Benson, conducted this unannounced annual visit. LPA toured the facility with Administrator Kristine Boban and Resident Care Director Susan Mosby. This facility has three buildings. Buildings one and two have fences around them and house residents with dementia. Building three does not have a fence and houses residents who do not have dementia. The meals are mainly prepared in building three and transported to the other two buildings. Eight staff and resident files were reviewed. Multiple topics discussed. -The following form shall be updated and submitted to Community Care Licensing Division (CCLD): LIC 309 Administrative Organization. A couple of issues need to be addressed. -Building three has flooring issues. The floor boards are lifting in places causing uneven areas. The uneven areas are not tripping hazards at this time and therefore not going to be cited, but it has the potential to become an issue in the future -The handrails in building one. The ends of the hand rails are missing and some of the ends have places to potentially snag clothes or even cause skin tears. The rail ends are curved and forms a handle of sorts and the residents grab and pull the ends off. LPAs did not observe any residents with skin tears or injuries. And because of this it is not getting cited. Several ideas were discussed to fix the handrails.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Kerry Hiratsuka	TELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: SIERRA OAKS OF REDDING	FACILITY NUMBER: 455002787
	VISIT DATE: 04/20/2023

NARRATIVE

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-Buildings one and two have fences around them and they have locked gates that require codes to open them. The facility is required to have a waiver to have the locked perimeter. This was not addressed in the application that was submitted and therefore not addressed by the application specialist from CCLD. The LPA who did the prelicensing visit did not address it. The facility is not being cited for this during this visit, but the licensee shall submit a waiver request for the locked waiver perimeter.

Per Care of Persons with Dementia 87705(l) The following initial and continuing requirements shall be met for the licensee to lock exterior doors or perimeter fence gates:
(1) Licensees shall notify the licensing agency of their intention to lock exterior doors and/or perimeter fence gates.
(2) The licensee shall ensure that the fire clearance includes approval of locked exterior doors or locked perimeter fence gates.
(3) The licensee shall obtain a waiver from Section 87468(a)(6), to prevent residents from leaving the facility.
(A) Facility staff shall attempt to redirect any unaccompanied resident(s) leaving the facility.
(4) The licensee shall maintain either of the following documents in the resident's record at the facility:
(A) The conservator's written consent for admission for each resident who has been conserved under the Probate Code or the Lanterman-Petris-Short Act; or
(B) A written statement signed by each non-conserved resident that states the resident understands that the facility has exterior door locks or perimeter fence gate locks and that the resident voluntarily consents to admission.
(5) Interior and exterior space shall be available on the facility premises to permit residents with dementia to wander freely and safely.
(6) Locked exterior doors or perimeter fences with locked gates shall not substitute for trained staff in sufficient numbers to meet the care and supervision needs of all residents.
(7) The licensee shall not accept or retain residents determined by a physician to have a primary diagnosis of a mental disorder unrelated to dementia.
(8) Fire and earthquake drills shall be conducted at least once every three months on each shift and shall include, at a minimum, all direct care staff.

no deficiencies cited.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Kerry Hiratsuka	TELEPHONE: (916) 591-0210
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

LIC809 (FAS) - (06/04)

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