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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525002362
Report Date: 01/23/2025
Date Signed: 01/23/2025 12:25:50 PM

Document Has Been Signed on 01/23/2025 12:25 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:SAIL HOUSE, INC., THEFACILITY NUMBER:
525002362
ADMINISTRATOR/
DIRECTOR:		CAREY, MICAHFACILITY TYPE:
735
ADDRESS:21125 LUTHER ROADTELEPHONE:
(530) 527-5780
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY: 23CENSUS: 22DATE:
01/23/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Micah Carey - administratorTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
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01/23/2025 10:15 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 # 7016278735 exp. 07/07/2026 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, six (6) 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. Medication administration system was reviewed. Medication is locked in a cabinet.

A Bedding, linens, and towels for clients were observed and found to be clean and in good repair.

Activities are planned according to the clients preferences. There is a calendar of activities and the clients go on community group outings regularly.

Continued on LIC809-C
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE: DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2025
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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Document Has Been Signed on 01/23/2025 12:25 PM - It Cannot Be Edited


Created By: Rebecca Knight On 01/23/2025 at 11:52 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: 01/23/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(a)
Building and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the licensee did not comply with the section cited above in 1 of 6 bathrooms which poses a potential health, safety or personal rights risk to persons in care. LPA observed bathroom fan non-operational in the little house. LPA observed mildew on ceiling above the shower in the same bathroom.
POC Due Date: 02/06/2025
Plan of Correction
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Licensee agrees to replace / repair the bathroom fan, clean mildewed area and paint the mildewed area if cleaning does not repair the mildew issue. Licensee shall submit photographs to LPA as proof of correction.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: 01/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2025


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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., THE
FACILITY NUMBER: 525002362
VISIT DATE: 01/23/2025
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The facility was observed to be at a comfortable temperature. Common area was clean and in good repair. All bedrooms had required furniture, bedding, and lighting. 5 of 6 bathrooms were clean and in good repair. LPA observed bathroom fan non-operational in the little house. LPA observed mildew on ceiling above the shower in the same bathroom. 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. Smoke detectors are all operational. The facility has a fire sprinkler system connected to the smoke alarm system which is inspected annually. The system was last inspected on 07/19/2024. No pools/bodies of water are on premises. The facility has been conducting emergency disaster drills 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: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025
LIC809 (FAS) - (06/04)
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