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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525920029
Report Date: 02/15/2024
Date Signed: 02/15/2024 10:31:21 AM

Document Has Been Signed on 02/15/2024 10:31 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:MASON'S RESIDENTIAL HOMES INC. #3FACILITY NUMBER:
525920029
ADMINISTRATOR:MASON, GAILFACILITY TYPE:
735
ADDRESS:125 TRENT LANETELEPHONE:
(530) 200-1745
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY: 4CENSUS: 0DATE:
02/15/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Gail Mason - licenseeTIME COMPLETED:
10:30 AM
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02/15/2024 09:00 AM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility to conduct their scheduled pre-licensing inspection. LPA met with licensees Dave and Gail Mason and Justin Bryant care staff and explained the purpose of the visit. Licensee waived COMP III presentation as they have been operating multiple facilities for several years.

LPA toured the facility inside and out. The inside of the facility was observed to be in good condition and repair. The facility has received fire clearance for four (4) ambulatory clients. The facility has four (4) client bedrooms, one (1) staff room, and four (4) bathrooms. LPA observed a large dining table with 6 chairs in the dining room. LPA observed two large couches in the common area with ample room for client seating.



Food storage meets Title 22 regulation requirements. Plates, utensils, pots, and pans were in place during the inspection. Dishwasher, stove, microwave, and refrigerators were all present and working.

The facility has 2 fully charged fire extinguishers which have been inspected by the fire marshal. LPA observed smoke alarms and carbon monoxide detectors fully functioning.

Continued on LIC809-C

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: MASON'S RESIDENTIAL HOMES INC. #3
FACILITY NUMBER: 525920029
VISIT DATE: 02/15/2024
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Bedrooms were observed to have furniture as required by Title 22 Regulations. All beds were made up with linens and bedspreads. The facility has a linen closet which contains bedding, and towels. Bathrooms were observed to be in good repair.

Storage and lighting are adequate in the home. Medications are to be stored in a locked cabinet. Cleaning supplies and toxins are locked up in a cabinet in the storage area. Knives are locked up in the kitchen. Washer and dryer observed in place and ready for use.

There is an office space where client and staff files will be stored in a locked cabinet.

The back yard has a covered porch that provides shade with a table, and chairs for the clients to use. There is a pool located in the back yard that is fully fenced with a self-closing, self-latching gate with an alarm.

The applicant has passed the pre-licensing portion of the application process. LPA will contact the Central Application Bureau.

Exit Interview and copy of report was provided to the licensee.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024
LIC809 (FAS) - (06/04)
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