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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 581302894
Report Date: 08/08/2024
Date Signed: 08/09/2024 10:08:49 AM

Document Has Been Signed on 08/09/2024 10:08 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:FEATHER RIVER MANORFACILITY NUMBER:
581302894
ADMINISTRATOR/
DIRECTOR:
TERRY, NORAFACILITY TYPE:
740
ADDRESS:3962 WEST ELLA AVE.TELEPHONE:
(530) 743-5022
CITY:OLIVEHURSTSTATE: CAZIP CODE:
95961
CAPACITY: 32CENSUS: 31DATE:
08/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Scott TerryTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On 8/8/2024 LPA Tryon visited the facility to complete the annual inspection visit. LPA met with Administrator Scott Terry. The facility currently has 31 residents.

LPA toured the facility including common areas, kitchen, storage, medication storage areas, food storage areas, storage for cleaners, hallways, bathrooms, resident rooms.
The facility consists of a main house, and two additional buildings that house resident bedrooms. There is also a separate building for laundry.
The facility is clean and nicely kept with needed repairs/painting being performed on a regular basis.
Bedrooms are appropriately furnished and cleaned. Bathrooms are clean and plumbing is functioning. Grab bars, etc. installed.
Smoke detectors, carbon monoxide detectors installed and functioning. There is a sprinkler system installed in the facility. Fire extinguishers are charged and checked regularly. Rooms have call buttons available to residents if needed.
Food supplies appear plentiful and varied, of good quality. Supplies meet requirement for 2 days perishable and 7 days non-perishable. Food appears to be stored appropriately.
The facility has adequate supply of cleaning and other supplies, as well as PPE.

Medications are centrally stored, locked and logged. Medications are stored in original containers.

LPA reviewed 4 resident files and 4 staff files. Files include appropriate documents. Staff receives regular training, are first aid certified. Admin. Certificate is current; liability insurance current.
At this time, LPA finds the facility to be in substantial compliance. No deficiencies were cited at this visit. Exit interview conducted.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Todd Tryon
LICENSING EVALUATOR SIGNATURE: DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/08/2024
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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