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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525002790
Report Date: 05/29/2024
Date Signed: 05/29/2024 11:27:40 AM

Document Has Been Signed on 05/29/2024 11:27 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:SERENITY RESIDENTIALFACILITY NUMBER:
525002790
ADMINISTRATOR/
DIRECTOR:		PHELPS, ASHLEYFACILITY TYPE:
735
ADDRESS:925 FRANKLIN STTELEPHONE:
(530) 200-2909
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY: 4CENSUS: 4DATE:
05/29/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:Michael Collin Harris - administratorTIME VISIT/
INSPECTION COMPLETED:
11:40 AM
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05/29/2024 9:50 AM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility unannounced to conduct a Required-1 Year inspection. LPA met with administrators Michael Collin Harris and Lauren Leak. LPA explained the purpose of the visit.

LPA Knight and staff toured the facility together to ensure the health and safety of residents in care. Areas toured include but are not limited to four (4) resident rooms, common areas, one (1) bathroom, kitchen, storage areas and back yard. Staff and resident files were reviewed.

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. Facility has required (7) seven-day non-perishable and (2) day perishable supply of food. Medication is locked in a cabinet.

Fire extinguishers fully charged and inspected. Smoke detectors are all operational. All employees requiring background checks are cleared.

There are no pools/bodies of water are on premises. Last disaster drill was conducted in February 2024 which was an earthquake drill, the facility has been conducting fire drills monthly. 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 administrator Michael Collin Harris.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE: DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/29/2024
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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