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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 471304415
Report Date: 08/03/2022
Date Signed: 08/04/2022 07:47:36 AM


Document Has Been Signed on 08/04/2022 07:47 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
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: 9DATE:
08/03/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:andee Crane, AdministratorTIME COMPLETED:
04:45 PM
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On 08/03/2022 Licensing Program Analyst (LPA) Misty Valencia, arrived at the facility unannounced to conduct a facility health and safety check due to a fire in the area. LPA met with Sandee Crane, Administrator and explained the purpose of the visit. Prior to initiating the annual inspection visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; contacted Facility and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. Additionally, LPA was screened by the front door.

On 07/31/2022 LPA contacted Administrator regarding fire in the community. Administrator reported that they are in a yellow (warning) area. All residents have a bag packed and ready to go if it becomes a mandatory evacuation.

On 08/03/2022 Administrator report that all nine (9) residents are packed and ready to go if need be. The plan is to go to the community center in Weed that is about thirty (30) minutes away. Administrator reports that all medications are ready for transport as well. Administrator reports that she has transportation plan and will have everyone transported safely. Administrator reported that the fire has moved north and the hospital has reopened up on Bruce Street that was evacuated on 07/31/2022.

No deficiencies are being cited as a result of todays inspection. Administrator will call and update LPA with any new changes. Exit interview conducted and copy of report emailed to the facility.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Misty ValenciaTELEPHONE: (530) 895-5820
LICENSING EVALUATOR SIGNATURE:
DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/03/2022
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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