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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525002623
Report Date: 10/26/2022
Date Signed: 10/26/2022 11:10:00 AM


Document Has Been Signed on 10/26/2022 11:10 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:BY THE RIVER ASSISTED LIVINGFACILITY NUMBER:
525002623
ADMINISTRATOR:O'SULLIVAN, LINDA KAYFACILITY TYPE:
740
ADDRESS:1095 LAKESIDE DRIVETELEPHONE:
(530) 727-9010
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY:6CENSUS: 6DATE:
10/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Sara WhiteTIME COMPLETED:
11:15 AM
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10/26/22 Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with caregiver/designee, Ms. White and explained the purpose of the visit. Prior to initiating the annual inspection, 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 administrator 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 Sara .

LPA and caregiver toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, six (6) resident bedrooms, two (2) bathrooms, kitchen, storage areas and back yard. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and the caregiver completed the infection control domain and facility was found to be in substantial compliance at this time.

No deficiencies are being cited as a result of todays inspection.
LPA advised about the use of fit tested masks in the event of Covid Positive cases in the home.
LPA requested, if not already submitted, that licensee submit their Emergency and Disaster plan as well as their Infection Control Plan.

Exit interview conducted and copy of report was given to Sara W..
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2022
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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