<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525002362
Report Date: 01/25/2024
Date Signed: 01/25/2024 11:13:38 AM

Document Has Been Signed on 01/25/2024 11:13 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:SAIL HOUSE, INC., THEFACILITY NUMBER:
525002362
ADMINISTRATOR:CAREY, CHRISFACILITY TYPE:
735
ADDRESS:21125 LUTHER ROADTELEPHONE:
(530) 527-5780
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY: 23CENSUS: 22DATE:
01/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Micah Carey - administratorTIME COMPLETED:
11:30 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
01/25/2024 9:45 AM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility unannounced to conduct a Required-1 Year inspection. LPA met with administrator Micah Carey and explained the purpose of the visit.

LPA Knight and the administrator toured the facility together to ensure the health and safety of clients in care. Areas toured include but are not limited to client rooms, common areas, two (2) bathrooms, showers, laundry room, kitchen, storage areas and back yard. Staff and resident files were reviewed. All employees requiring background checks are cleared. Administrator certificate is current. .

Activities are planned according to the clients preferences.Bedding, linens, and towels for clients were observed and found to be clean and in good repair. Medication is locked in a cabinet.

The facility was observed to be at a comfortable temperature. Hot water measured between 105 – 120 degrees F. Common area was clean and in good repair. The licensee is removing the existing carpet in the common area and replacing it with new carpet. All bedrooms had required furniture, bedding, and lighting. Bathrooms were clean and in good repair. Kitchen was clean and in good repair. Food appears to be stored and prepared properly. Facility has required (7) seven-day non-perishable and (2) day perishable supply of food. Fire extinguishers fully charged and were inspected. Smoke detectors are all operational. No pools/bodies of water are on premises. No firearms are on premises. The facility has been conducting emergency disaster drill every six months and fire drills monthly.

A deficiency is being cited as a result of today's inspection and is documented on the attached LIC809-D. Appeal rights provided.

Exit interview conducted and copy of report was provided to administrator Micah Carey.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 01/25/2024 11:13 AM - It Cannot Be Edited


Created By: Rebecca Knight On 01/25/2024 at 11:00 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SAIL HOUSE, INC., THE
FACILITY NUMBER: 525002362

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/25/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80075(f)
Health-Related Services
(f) Staff responsible for providing direct care and supervision shall receive training in first aid from persons qualified by agencies including but not limited to the American Red Cross.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 2 out of 3staff files which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/08/2024
Plan of Correction
1
2
3
4
Two of the staff files reviewed had expired first aid training cards on file. Licensee to ensure that all staff receive first aid training from a certified instructor who can provide proof of training in the form of First Aid cards or certificates in a timely manner. A copy shall be kept in each staff file and updated as required. Licensee shall submit name, website and telephone number of vendor as proof of correction. In addition licensee shall send LPA updated first aid cards for the 2 staff.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lauren Crocker
LICENSING EVALUATOR NAME:Rebecca Knight
LICENSING EVALUATOR SIGNATURE:
DATE: 01/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/25/2024


LIC809 (FAS) - (06/04)
Page: 2 of 2