<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 550307827
Report Date: 02/15/2024
Date Signed: 02/15/2024 03:53:12 PM

Document Has Been Signed on 02/15/2024 03:53 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:DIANA MORECIFACILITY TYPE:
735
ADDRESS:20470 BAY MEADOWS DRIVETELEPHONE:
(209) 533-3708
CITY:SONORASTATE: CAZIP CODE:
95370
CAPACITY: 14CENSUS: 14DATE:
02/15/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Diana MoreciTIME COMPLETED:
04:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 2/15/24 Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct a case management visit. LPA Jensen met with Administrator Diana Moreci and explained the purpose of today's visit.

LPA Jensen was notified by a service coordinator with the Valley Mountain Regional Center that there was construction in progress at the home. LPA Jensen interviewed the Administrator who advised that the facility was adding 2 bathrooms and a laundry room as an addition to the home. The addition is located where an outdoor area overhang existed. LPA Jensen toured the facility and determined that the construction is not currently impacting client care. The Administrator advised that this project is anticipated to take an additional 6-8 weeks. While the Regional Center was notified about the construction project, the Department was not notified. During the course of the visit the Administrator provided LPA Jensen blue prints of the project, permits and a new facility sketch.

A deficiency is being cited pursuant to the California Code of Regulations (CCR) Title 22, Division 6.

An exit interview was conducted and a copy of this report and appeal rights were provided.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maja Jensen
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
Document Has Been Signed on 02/15/2024 03:53 PM - It Cannot Be Edited


Created By: Maja Jensen On 02/15/2024 at 03:38 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SIERRA FOOTHILLS RESIDENTIAL CARE, INC.
FACILITY NUMBER: 550307827

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/15/2024
Section Cited
CCR
80086(a)

1
2
3
4
5
6
7
Alterations to Existing Building or New Facilities
Prior to construction or alterations, all licensees shall notify the licensing agency of the proposed change. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
The Administrator provided LPA Jensen contruction blue prints, building permits and a new facility sletch. No further plan of correction is required.
8
9
10
11
12
13
14
Based on LPA Jensen's observation of an addition to the facility under construction and verification that there is no record of notification given to the Department. This poses a potential health, safety and personal rights risk to residents in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lisa Rios
LICENSING EVALUATOR NAME:Maja Jensen
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2024


LIC809 (FAS) - (06/04)
Page: 2 of 2