455002787-3-12-2024-59-AS-JBOS-D3ASC6-20240312134502

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 455002787
Report Date: 03/12/2024
Date Signed: 03/12/2024 01:45:10 PM

Document Has Been Signed on 03/12/2024 01:45 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:	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: 79	DATE:	03/12/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Administrator- Kristine Boban		TIME COMPLETED:	02:00 PM

NARRATIVE

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On 03/12/2024, Licensing Program Analyst (LPA) Jaynae Boyles, arrived at the facility unannounced to conduct a 1-Year Required Annual Inspection. LPA met with Facility Administrator, Kristine Boban and explained the purpose of the visit.

LPA Boyles and Administrator toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, activity rooms, medication rooms, laundry rooms and common restrooms. LPA observed the facility to be clean, and odor-free.

LPA observed each bathroom to have the necessary, no non-skid flooring, grab bars and/or shower chair, paper towels, trash can with lids and 20-second hand-washing poster. LPA observed two of bathrooms have damage. LPA observed each resident bedrooms to have the required furnishings, working lights and windows with screens. LPA observed the activity rooms to be fully equip with the a plethora of supplies for the scheduled activities. LPA observed the medication room to be clean and organized, locked and inaccessible to residents in care. LPA observed the first aid kit to be completed and ready for use. LPA measured the water in several locations throughout the facility which was within the regulation range. LPA observed the laundry room to be locked which leaves the toxic chemicals inaccessible to residents. Facility has a 2-day perishable and a 7-day non-perishable amount of food. The facility had a variety of food to offer the residents. The kitchen was clean and organized.

LPA observed several fire extinguishers, fire detectors, and carbon monoxide detectors thought out the facility.

LPA reviewed a total of seven (5) residents' files and five (6) staff files which contained all the required documentation.

Several topics were discussed.

As a result of this visit, deficiencies were cited per California Code of Regulations, Title 22. Exit interview conducted and copy of this report, 809D, and appeals rights given at the conclusion of this visit.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Jaynae Boyles	TELEPHONE: (916) 208-6251
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024

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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Document Has Been Signed on 03/12/2024 01:45 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SIERRA OAKS OF REDDING	FACILITY NUMBER: 455002787
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/12/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87303(a)

Maintenance and Operation

The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in two out of eleven bathrooms had damage which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 03/19/2024
	Plan of Correction
1 2 3 4	Licensee will repair the damage to the bathrooms within one week.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Jaynae Boyles	TELEPHONE: (916) 208-6251
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2024

LIC809 (FAS) - (06/04)

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