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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002835
Report Date: 07/27/2023
Date Signed: 07/27/2023 02:51:07 PM

Document Has Been Signed on 07/27/2023 02:51 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:PREMIER SOLUTIONSFACILITY NUMBER:
455002835
ADMINISTRATOR:LARMOUR, DEBBIEFACILITY TYPE:
775
ADDRESS:2875 CHURN CREEK RDTELEPHONE:
(530) 375-0528
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY: 35CENSUS: 24DATE:
07/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:26 PM
MET WITH:Shelly CoullahanTIME COMPLETED:
03:10 PM
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On 07/27/2023, Licensing Program Analyst (LPA) Ivan Avila, arrived at the facility unannounced to conduct a 1-Year Required Annual Inspection. LPA met with Program Director, Shelly Coullahan and explained the purpose of the visit.

LPA Avila and Program Director toured facility together to ensure health and safety of individuals in care. Areas toured include but are not limited to: common areas, and common restrooms. LPA observed the facility to be clean, in good repair and odor-free and each bathroom to have the necessary grab bars, paper towels, trash can with lids and 20-second hand-washing poster. Facility has all sharps to be locked. Hot water temperature was measured at 113 F. LPA observed four (4) fire extinguishers, fire detectors, and carbon monoxide detectors. In the areas toured no immediate health, safety, or personal rights violations were observed.

LPA reviewed a total of three (3) residents' files and three (3) staff files.

No deficiencies are being cited as a result of today’s inspection.

Exit interview conducted and copy of report left at the facility.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Ivan Avila
LICENSING EVALUATOR SIGNATURE: DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/27/2023
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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