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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455920100
Report Date: 06/24/2024
Date Signed: 06/24/2024 11:11:31 AM

Document Has Been Signed on 06/24/2024 11:11 AM - 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:SAPPHIRE RESIDENTIALFACILITY NUMBER:
455920100
ADMINISTRATOR/
DIRECTOR:		LEAK, RANDYFACILITY TYPE:
735
ADDRESS:1208 COGGINS STREETTELEPHONE:
(530) 200-0701
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY: 4CENSUS: 0DATE:
06/24/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Adminstrator- Randy Leak TIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 06/24/2024, Licensing Program Analyst (LPA) Jaynae Boyles arrived at the facility announced to conduct a Pre licensing Inspection. LPA met with Facility Administrator, Randy Leak and explained the purpose of the visit.

LPA Boyles and Administrator toured facility together to ensure that the facility is ready to take its first clients. Areas toured include but are not limited to: common areas, bedrooms, garage, backyard, and restrooms. LPA observed all the resident bedrooms to have all the required furnishings, working lights and windows with screens. LPA observed bathrooms to have necessary grab bars and trash cans with lids. LPA observed fire extinguishers, smoke alarms and CO2 indicators.

LPA observed the facility to be clean, in good repair and odor-free.

Component III was waived during this inspection as the licensee has four licensed facility.

This facility is ready to be licensed.

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

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Jaynae Boyles
LICENSING EVALUATOR SIGNATURE: DATE: 06/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2024
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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