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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455001470
Report Date: 11/18/2024
Date Signed: 11/18/2024 03:37:47 PM

Document Has Been Signed on 11/18/2024 03:37 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:LAKE REDDING MANORFACILITY NUMBER:
455001470
ADMINISTRATOR/
DIRECTOR:		CAIN, MATTHEWFACILITY TYPE:
740
ADDRESS:739 DELTA STREETTELEPHONE:
(530) 241-9566
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY: 6CENSUS: 6DATE:
11/18/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:15 PM
MET WITH:Caregiver, Amanda Ratcliff
Administrator, Betty Cain		TIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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On November 18, 2024 at approximately 3:15 PM, Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Lake Redding Manor for the purpose of conducting a Case Management-Other inspection regarding an appeal that was granted and the citation reduced down to a LIC 9102-Technical Violation (See AMENDED LIC 809-Case Management-Deficiencies Inspection dated for August 28, 2024). LPA was greeted at the door by Caregiver, Amanda Ratcliff, and was granted access into the facility. Administrator arrived 15 minutes later.

LPA delivered the amended report outlining the LIC 9102-Technical Violation and explained to the Administrator the importance of ensuring that medications are given as outlined in Title 22 Regulations and doctors orders. LPA advised the Facility Administrator that if a similar occurrence happens the facility will be cited.

No deficiencies were cited during today's Case Management-Other inspection. LIC 9102-Technical Violation was issued for the AMENDED Case Management-Deficiencies Inspection Report dated for August 28, 2024. Exit interview was conducted, and a copy of this report was signed and given to the Administrator.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE: DATE: 11/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2024
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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