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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 471304415
Report Date: 05/05/2021
Date Signed: 05/14/2021 04:23:49 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:YREKA GUEST HOMEFACILITY NUMBER:
471304415
ADMINISTRATOR:CRANE, SANDEE JOYFACILITY TYPE:
740
ADDRESS:520 N. MAINTELEPHONE:
(530) 842-4235
CITY:YREKASTATE: CAZIP CODE:
96097
CAPACITY:12CENSUS: 8DATE:
05/05/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
05:30 PM
MET WITH:Crane, Sandee AdministratorTIME COMPLETED:
05:31 PM
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On 5/5/2021 12pm-1pm Infection Preventionist Kristy Trausch, LPA Valencia, Tyler Johnson, Siskiyou Infection Prevention and met with Administrator Sandee Crane for an infection control meeting recommendations.

Following items were concluded in the meeting as well as any questions Admin Crane had
-Cleaning supplies and making sure they were up to EPA Standards
-Staff back up plan in case of outbreak
-Resident checks and to look for any signs/symptoms of Covid
-PPE supplies
-Visitation plans
-Testing for Covid and meeting state surveillance requirements
-Activities and the need for continuing social distancing


Admin was grateful for visit and all the information that was provided to her. She stated that she will contact LPA if she has any questions.
SUPERVISOR'S NAME: Kevin MknellyTELEPHONE: (209) -81-1925
LICENSING EVALUATOR NAME: Misty ValenciaTELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2021
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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