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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045000700
Report Date: 01/04/2022
Date Signed: 01/04/2022 01:50:59 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:COURTYARD AT LITTLE CHICO CREEK, THEFACILITY NUMBER:
045000700
ADMINISTRATOR:MORALES, MELISSAFACILITY TYPE:
740
ADDRESS:1770 HUMBOLDT ROADTELEPHONE:
(530) 342-0707
CITY:CHICOSTATE: CAZIP CODE:
95928
CAPACITY:49CENSUS: 35DATE:
01/04/2022
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:59 PM
MET WITH:Administrator Melissa MoralesTIME COMPLETED:
02:15 PM
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On 1/4/2022 at about 1:00 PM. Licensing Program Analyst (LPA) Jaclyn Avila arrived at the facility unannounced to conduct a Required -1 Year Inspection utilizing the infection control domain. LPA met with Executive Director Melissa Morales and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: PAPR. LPA Avila was screened by facility staff.

LPA Avila toured the facility to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, bathrooms, office, activity room, dining room, screening station, and storage areas. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA Avila and the Executive Director completed the infection control domain and facility was found to be in substantial compliance at this time.

No deficiencies are being cited as a result of todays inspection.

Exit interview conducted and copy of report was emailed to Executive Director Melissa Morales.
SUPERVISOR'S NAME: Rayna L BrysonTELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Jaclyn AvilaTELEPHONE: (530) 895-4275
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2022
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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