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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 585000879
Report Date: 07/18/2024
Date Signed: 07/19/2024 11:08:00 AM

Document Has Been Signed on 07/19/2024 11:08 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:WARNER'S FAMILY HOMEFACILITY NUMBER:
585000879
ADMINISTRATOR/
DIRECTOR:		WARNER, MICHAELFACILITY TYPE:
735
ADDRESS:4583 #C ARDMORE AVE.TELEPHONE:
(530) 743-2341
CITY:OLIVEHURSTSTATE: CAZIP CODE:
95961
CAPACITY: 6CENSUS: 4DATE:
07/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Michael Warn AdministratorTIME VISIT/
INSPECTION COMPLETED:
05:00 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 7/18/24 LPA Tryon visited the facility to do an annual inspection. LPA met with Administrator Michael Warner.
LPA toured the facility with Mr. Warner including common areas, kitchen, bedrooms, hallways, storage, outside, patio areas, pool area with locked fence, storage sheds, etc.
The home is clean and well-furnished, plenty of food supplies.
Resident rooms have required furnishings and private client belongings.
LPA reviewed the CARE Tool with Mr. Warner.
LPA reviewed 2 staff files and 2 resident files, Files included all required documents.
LPA interviewed 2 residents.
Residents appear to be treated well and be happy living at the facility.

At this time, the facility appears to be in substantial compliance with regulations. No deficiencies were cited at this visit.

Exit interview conducted.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Todd Tryon
LICENSING EVALUATOR SIGNATURE: DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/18/2024
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 1