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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045000700
Report Date: 03/14/2024
Date Signed: 03/14/2024 10:57:01 AM


Document Has Been Signed on 03/14/2024 10:57 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: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: 39DATE:
03/14/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Adminstrator- Melissa Morales TIME COMPLETED:
11:15 AM
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LPA received a call that the administrator was under the influence and activity drinking will disbursing medications for the facility.

LPA arrived at the facility to discuss the incident reported. LPA toured the medication room and viewed the video footage for the last two days. There was no video footage that the administrator consumed alcohol while working and disbursing medications.

Administrator reported that she is having challenges with an employee, who may have made reported this incident. Furthermore, the administrator reported that she does not drink alcohol.

There is no evidence to support that the incident reported occurred.

An exit interview was conducted. A copy of the report was provided to administrator.


SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Jaynae BoylesTELEPHONE: (916) 208-6251
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2024
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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