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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525002806
Report Date: 07/29/2024
Date Signed: 07/29/2024 03:38:32 PM


Document Has Been Signed on 07/29/2024 03:38 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:GILMORE PLACEFACILITY NUMBER:
525002806
ADMINISTRATOR:WILCOX, JULIEFACILITY TYPE:
740
ADDRESS:70 GILMORE ROADTELEPHONE:
(530) 727-9293
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY:22CENSUS: 21DATE:
07/29/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Julie Wilcox - administratorTIME COMPLETED:
02:15 PM
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07/29/2024 12:30 PM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility unannounced to conduct a Required-1 Year inspection. LPA met with administrator Julie Wilcox 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 twelve (12) client rooms, common areas, three and one half (3.5) bathrooms, kitchen, storage areas and office. Staff and resident files were reviewed. All employees requiring background checks are cleared.

Bedding, linens, and towels for clients were observed and found to be clean and in good repair. Medication is locked in a cabinet. Administrator applied for renewal of administrator certificate in April 2024 and will send LPA a copy of their new certificate once received.

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 in February 2024. Smoke detectors are all operational, are hard wired to the local fire department and serviced by Beacon Fire Alarms & Security Corporation. There are no pools/bodies of water are on premises. The facility has been conducting fire drills monthly.

LPA requested copies of the following documents:
LIC308 Designation of Facility Responsibility
LIC500 Personnel Report

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 Julie Wilcox.

SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:
DATE: 07/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/29/2024
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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