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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525002699
Report Date: 10/03/2023
Date Signed: 10/03/2023 01:42:07 PM

Document Has Been Signed on 10/03/2023 01:42 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: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:
10/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:21 AM
MET WITH:Chantelle Browning - administratorTIME COMPLETED:
01:30 PM
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10/03/2023 11:20 AM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility unannounced to conduct a Required-1 Year inspection. LPA met with administrator Chantelle Browning ( 6065849735 exp. 02/02/2025) 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 six (6) client rooms, common areas, three (3) bathrooms, kitchen, storage areas and back yard. Staff and resident files were reviewed. All employees requiring background checks are cleared. Administrator certificate is current.

Bedding, linens, and towels for clients were observed and found to be clean and in good repair. There is an adequate supply of toiletries for the clients. Medication is locked in a cabinet. There is a pool on the premises that is fenced and inaccessible to clients.

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. 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 firearms are on premises. The facility has been conducting fire drills monthly and emergency disaster drills every 6 months.

The following deficiencies were observed during the visit: LPA observed large broken mirror in downstairs bathroom that needs to be replaced. LPA observed broken freezer drawer inside of lower portion of refrigerator located in the kitchen which needs to be repaired. LPA observed wood burning stove in the common area of the facility that is accessible to clients.

Deficiencies are being cited as a result of today’s inspection and are included on the attached LIC809-D.

Exit interview conducted and copy of report was provided to administrator Chantelle Browning

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2023
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 10/03/2023 01:42 PM - It Cannot Be Edited


Created By: Rebecca Knight On 10/03/2023 at 12:45 PM
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: INSPIRED RESIDENTIAL WALKER RANCH
FACILITY NUMBER: 525002699

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/03/2023

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 LPA observation, the licensee did not comply with the section cited above. LPA observed large broken mirror in downstairs bathroom that needs to be replaced. LPA observed broken freezer drawer inside of lower portion of refrigerator located in the kitchen which needs to be repaired. which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/17/2023
Plan of Correction
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Licensee agrees to replace the large mirror in the downstairs bathroom and send LPA photograph of replacement. Licensee agrees to repair the broken drawer in the freezer of the refirgerator that is located in the kitchen and will send photograph as proof of repair.
Type B
Section Cited
CCR
80088(c)


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation LPA observed wood burning stove in the common area of the facility that is accessible to clients which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/17/2023
Plan of Correction
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Licensee shall make wood buring stove inaccessible to clients. Licensee shall submit photograph as proof of correction.
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: 10/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/03/2023


LIC809 (FAS) - (06/04)
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