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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 550307827
Report Date: 08/13/2024
Date Signed: 08/13/2024 03:57:26 PM

Document Has Been Signed on 08/13/2024 03:57 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:SIERRA FOOTHILLS RESIDENTIAL CARE, INC.FACILITY NUMBER:
550307827
ADMINISTRATOR/
DIRECTOR:		DIANA MORECIFACILITY TYPE:
735
ADDRESS:20470 BAY MEADOWS DRIVETELEPHONE:
(209) 533-3708
CITY:SONORASTATE: CAZIP CODE:
95370
CAPACITY: 14CENSUS: 13DATE:
08/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Diana MoreciTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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On 8/13/24 Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct a required 1 year annual inspection. LPA Jensen met with Administrator Diana Moreci and explained the purpose of today's visit.

LPA Jensen toured the grounds and observed all pathways to be free of obstruction. All window screens were observed to be in good repair. There is a shaded area for client outdoor activities. There are some items in the backyard covered by a tarp that are ready to be disposed of according to the Administrator. The facility has live chickens that clients can assist in caring if they choose. There are also gardens on the grounds that residents can assist in maintaining.

LPA Jensen toured the interior physical plant. The facility has adequate furnishing and lighting. The bathrooms have been newly renovated, The bathroom water temperature was measured at 112 degrees Fahrenheit which falls within the required range of 105-120 degrees. The temperature was approximately 73 degrees and comfortable. The carbon monoxide detector was tested and found to be good in working order. The smoke detectors are hard wired. The fire extinguisher was last serviced in November of 2023 and is in compliance. The emergency disaster plan was reviewed and is in compliance.

LPA Jensen observed a 2 day supply of perishable food and a 7 day supply of non-perishable food. The menu was posted in a prominent location. Non-perishable food is maintained in a storage unit in the back yard. Technical assistance was provided on keeping the storage area free of insects. LPA Jensen reviewed 5 resident files and 4 staff files and found them to be compliant. LPA Jensen interviewed 1 client, 1 client was sleeping and all others were on outings or occupied. The inspection tool was used during the course of this visit. The facility was determined to be in substantial compliance. An exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE: DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2024
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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