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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525920061
Report Date: 12/13/2023
Date Signed: 12/13/2023 11:59:43 AM

Document Has Been Signed on 12/13/2023 11:59 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 #2FACILITY NUMBER:
525920061
ADMINISTRATOR:MASON, DAVIDFACILITY TYPE:
735
ADDRESS:820 OTIS CT.TELEPHONE:
(530) 949-7698
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY: 4CENSUS: 3DATE:
12/13/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:56 AM
MET WITH:Dave & Gail Mason - administratorsTIME COMPLETED:
12:00 PM
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12/13/2023 11:00 AM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility to conduct their scheduled pre-licensing inspection. LPA met with Dave & Gail Mason and explained the purpose of the visit. This is an existing facility, the licensee changed the corporate structure which required this prelicensing visit.

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 three (3) client bedrooms, one (1) staff room, and one (1) bathroom. LPA observed a large dining room table with 6 chairs in the dining room. LPA observed a couch and loveseat in the common area.



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

The facility has (1) fully charged fire extinguisher which has been inspected by the fire marshal. LPA observed smoke alarms and carbon monoxide detectors fully functioning.

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 towels and face cloths. Bathroom was observed to be in good repair.

Storage and lighting are adequate in the home. Medications are stored in a locked cabinet. Cleaning supplies and toxins are locked up in a cabinet.. Also locked in the kitchen are knives. Washer and dryer observed in place and ready for use.



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

The back yard has shade trees and shade structure with a table, and chairs for the clients to use.

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 administrators.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2023
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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