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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525002699
Report Date: 10/26/2022
Date Signed: 10/26/2022 03:07:55 PM


Document Has Been Signed on 10/26/2022 03:07 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:INSPIRED RESIDENTIAL WALKER RANCHFACILITY NUMBER:
525002699
ADMINISTRATOR:LEAK, RANDYFACILITY TYPE:
735
ADDRESS:12810 WALKER WAYTELEPHONE:
(530) 200-2909
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY:6CENSUS: 6DATE:
10/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Chantelle BrowningTIME COMPLETED:
03:00 PM
NARRATIVE
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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 house manager Chantel Browning 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; LPA completed a facility risk assessment upon arrival. 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 facility staff.

LPA and Ms. Browning 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, three (3) bathrooms, kitchen, storage areas and office.
LPA advised window screens to Rms 1 and 6, the pool fence and downstairs mirror be repaired as discussed. LPA observed hot water warning signs at all faucet locations. One measure of 130' F taken. LPA will conduct further file review before further advise. S1 was found to not be finger print cleared (citation issued). S2 was cleared but not yet associated (association done while LPA present).
LPA and the house manager completed the infection control domain and facility was found to be in substantial compliance at this time.

Deficiency is being cited as a result of todays inspection. Technical assistance also was provided.

Exit interview conducted and copy of report was emailed to Chantel Browning.
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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Document Has Been Signed on 10/26/2022 03:07 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926


FACILITY NAME: INSPIRED RESIDENTIAL WALKER RANCH
FACILITY NUMBER: 525002699

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/26/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80065(i)(1)
Personnel Requirements
(i) Prior to employment or initial presence in the facility, all employees and volunteers subject to a criminal record review shall:
(1) Obtain a California clearance or a criminal record exemption as required by law or Department regulations or


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and records review, the licensee did not comply with the section cited above in S1 had not completed background check clearance which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/27/2022
Plan of Correction
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S1 was removed from the scheedule while LPA was present and will not return unless/ until cleared.
Licensee will submit a statement of understanding of this requirement by the POC date of 10/27/22.
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: 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 appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2022
LIC809 (FAS) - (06/04)
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