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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002943
Report Date: 12/27/2023
Date Signed: 12/27/2023 12:43:07 PM

Document Has Been Signed on 12/27/2023 12:43 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:ICAREHOMES INC.FACILITY NUMBER:
455002943
ADMINISTRATOR:HOOKHAM, MARIELFACILITY TYPE:
735
ADDRESS:3457 CAPRICORN WAYTELEPHONE:
(530) 917-6995
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY: 6CENSUS: 1DATE:
12/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Mariel HookhamTIME COMPLETED:
01:00 PM
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On 12/27/20230 Licensing Program Analyst (LPA) Ivan Avila arrived at the facility unannounced to conduct a 1-year annual inspection and met with Mariel Hookham and explained the purpose of the visit. LPA Avila and Administrator toured the facility together to ensure the health and safety of residents in care. Administrator has current certificate: #6051912735 and expires 04/10/2025.

Kitchen: The kitchen appeared clean and the appliances and fixtures functional during the time of visit. The LPA observed a sufficient supply of perishable and non-perishable food at the facility; Sharp objects are stored in locked cabinet. Hot water temperature measured at 118 degrees. Bedrooms: The LPA observed resident bedrooms furnished with at least one night stand, bed, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, and blankets. Bathrooms: The LPA observed the resident’s bathroom to be clean, and properly supplied. Residents have sufficient supplies for personal hygiene. Common Areas: These included but are not limited to the living, and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. Surrounding Grounds (Outdoors): The LPA observed appropriate outdoor furniture, with a covered shaded area for residents. There are no bodies of water or fire arms on the premises. LPA observed the garage where the washer and dryer are held. Cleaning supplies are locked in a cabinet inaccessible to residents. Record Review: A review of facility files was initiated. The LPA observed documentation of Infection Control, Disaster prevention and fire drill log. The LPA reviewed one (1) staff, and one (1) resident files. Medications: Medications are centrally stored and locked in a cabinet inaccessible to residents in care; medications are labeled and checked for expiration dates. No deficiencies cited during today's visit. Exit interview conducted and copy of the report and provided to Mariel Hookham.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Ivan Avila
LICENSING EVALUATOR SIGNATURE: DATE: 12/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/27/2023
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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