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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525002796
Report Date: 04/23/2024
Date Signed: 04/23/2024 01:41:53 PM

Document Has Been Signed on 04/23/2024 01:41 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:CORNING ADULT SUPPORT CENTERFACILITY NUMBER:
525002796
ADMINISTRATOR/
DIRECTOR:		MANNING, WHITNEYFACILITY TYPE:
775
ADDRESS:720 HOAG STREETTELEPHONE:
(530) 824-4562
CITY:CORNINGSTATE: CAZIP CODE:
96021
CAPACITY: 45CENSUS: 29DATE:
04/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:25 PM
MET WITH:Administrator- Whitney Manning TIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On 04/23/2023, Licensing Program Analyst (LPA) Jaynae Boyles, arrived at the facility unannounced to conduct a 1-Year Required Annual Inspection. LPA met with Facility Administrator,Whitney Manning, and explained the purpose of the visit.

LPA Boyles and Administrator toured facility together to ensure health and safety of residents in care.

LPA observed the facility to be clean, in good repair and odor-free. In the areas toured no immediate health, safety, or personal rights violations were observed.

Areas toured include but are not limited to: common areas, and common restrooms.

This facility has three activity rooms for scheduled activities. LPA observed a plethora of supplies for the scheduled activities provided at the facility.

LPA observed each bathroom to have the necessary grab bars, paper towels, trash can with lids and 20-second hand-washing poster. LPA observed three (3) fire extinguishers, fire detectors, and carbon monoxide detectors. LPA observed the first aid kit to be complete and ready for emergency use. LPA observed a complete emergency disaster plan and the required emergency disaster drills conducted at the facility to include staff and participants of the facility.

LPA observed medication and toxic chemicals to be locked and inaccessible to residents.

LPA reviewed a total of six (6) residents' files and six (6) staff files which contained all of the required documentation.

As a result of this visit, no deficiencies were cited per California Code of Regulations, Title 22. Exit interview conducted and copy of report given at the conclusion of this visit.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Jaynae Boyles
LICENSING EVALUATOR SIGNATURE: DATE: 04/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/23/2024
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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