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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525002514
Report Date: 08/27/2024
Date Signed: 08/27/2024 11:05:47 AM

Document Has Been Signed on 08/27/2024 11:05 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:JEWEL RESIDENTIAL INC. (ALDER)FACILITY NUMBER:
525002514
ADMINISTRATOR/
DIRECTOR:		MORENO, KELIFACILITY TYPE:
735
ADDRESS:935 ALDER ST.TELEPHONE:
(530) 527-8571
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY: 6CENSUS: DATE:
08/27/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Keli Moreno - licensee / administratorTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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08/27/2024 9:30 AM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility unannounced to conduct a Required-1 Year inspection. LPA met with licensee Keli Moreno and explained the purpose of the visit.

LPA Knight and the licensee toured the facility together to ensure the health and safety of clients in care. Areas toured include but are not limited to four (4) client rooms, common areas, four (4) bathrooms, kitchen, storage areas, and patio. Staff and resident files were reviewed. All employees requiring background checks are cleared.

A weekly house meeting is held to decide on events that will occur during the following week and clients are given a choice of activities. The facility also has a monthly calendar of community events that clients can choose from. 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. 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 in July 2024. Smoke detectors are all operational. No pools/bodies of water are on premises. Last disaster drill was conducted in June 2024 which was a flood drill, the facility has been conducting fire drills monthly.

LPA requested the following documents to update facility file:
LIC500 Personnel report
Administrator certificate

In the areas toured no immediate health, safety, or personal rights violations were observed. No deficiencies are being cited as a result of today’s inspection.

Exit interview conducted and copy of report was provided to licensee Keli Moreno

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE: DATE: 08/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/27/2024
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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