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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315920040
Report Date: 09/27/2024
Date Signed: 09/27/2024 04:09:45 PM

Document Has Been Signed on 09/27/2024 04:09 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:SIERRA RIDGE SENIOR LIVINGFACILITY NUMBER:
315920040
ADMINISTRATOR/
DIRECTOR:		JENNIFER FUSTONFACILITY TYPE:
740
ADDRESS:3625 BLUE OAKS DRTELEPHONE:
(530) 718-1553
CITY:AUBURNSTATE: CAZIP CODE:
95602
CAPACITY: 65CENSUS: 49DATE:
09/27/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Jennifer Fuston, Executive DirectorTIME 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 9/27/2024 LPA Tryon visited the facility to do a Wellness Check related to a report received by the Department on 9/26/2024.

LPA toured the facility including common areas, resident rooms, kitchen, dining area, bathrooms, etc.
The facility appears to be clean and free of hazards, food supplies look appropriate to meet requirement fo 2 days perishable and 7 days non-perishable. Medications are centrally stored and locked. LPA was able to speak briefly with a few residents. There was a large group of residents in a large common room at the back of the building, participating in an afternoon activity. There were also several residents chatting with each other in the sitting area just inside the front door.
Overall residents appeared to be safe and comfortable during this visit.

At this time, LPA notes no hazards or pressing issues at the facility.

Exit interview conducted.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Todd Tryon
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2024
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