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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 125000579
Report Date: 03/30/2023
Date Signed: 03/30/2023 12:02:15 PM

Document Has Been Signed on 03/30/2023 12:02 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:TIMBER RIDGE AT EUREKAFACILITY NUMBER:
125000579
ADMINISTRATOR:FARNUM, LARONAFACILITY TYPE:
740
ADDRESS:2740 TIMBER RIDGE LANETELEPHONE:
(707) 443-3000
CITY:EUREKASTATE: CAZIP CODE:
95503
CAPACITY: 75CENSUS: 52DATE:
03/30/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Larona FarnumTIME COMPLETED:
12:15 PM
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At approximately 8:30AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced, to complete the Required Annual inspection. LPA met with Executive Director Larona Farnum. At approximately 8:45AM, LPA reviewed the remaining 5 of 10 resident records. LPA observed 3 of 10 resident records did not contain Pre placement appraisals and current assessments. LPA was informed the appraisals were in process and they were waiting on input from responsible parties.
At approximately 10:30AM, LPA reviewed 10 staff records. Staff records contained the required documentation and training records.

At approximately 12:00PM, LPA reviewed this report with the Executive Director and concluded the inspection.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE: DATE: 03/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/30/2023
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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