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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045000700
Report Date: 01/14/2025
Date Signed: 01/14/2025 01:32:22 PM

Document Has Been Signed on 01/14/2025 01:32 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:COURTYARD AT LITTLE CHICO CREEK, THEFACILITY NUMBER:
045000700
ADMINISTRATOR/
DIRECTOR:		MORALES, MELISSAFACILITY TYPE:
740
ADDRESS:1770 HUMBOLDT ROADTELEPHONE:
(530) 342-0707
CITY:CHICOSTATE: CAZIP CODE:
95928
CAPACITY: 49TOTAL ENROLLED CHILDREN: 0CENSUS: 41DATE:
01/14/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Administrator, Melissa AcevesTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On January 14, 2025 at approximately 11:15 AM, Licensing Program Analyst (LPAs), Farhaan Sarangi and Kayla Adkinson arrived unannounced at Courtyard at Little Chico Creek, The for the purpose of conducting a Required 1 year inspection. LPAs met with Administrator, Melissa Aceves and was granted access into the facility.

LPAs and Administrator toured the facility. LPAs observed the facility to be clean and at a comfortable temperature with all exits free from obstruction. Fire Extinguisher was found to be last charged on February 2024 at the time of the inspection. All smoke and carbon detectors sound directly to the fire station. Water temperature in facility bathroom measured at 108 degrees, within acceptable range of 105 to 120 degrees F. LPAs observed sufficient perishable and non-perishable foods located in the kitchen. There are special provisions made for individuals with special dietary needs. Food menu was presently available for viewing during the inspection. Medications were centrally stored and locked. Cleaning products and other toxins are located in a locked room that was inaccessible to residents in care. There was a supply of linens, cleaners, hygiene products and paper products available for residents. All bathrooms designated for residents in the common areas at the facility were supplied with individual paper towels and hand soap. Bathrooms in resident’s rooms have a towel and soap. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. A tour of occupied bedrooms were conducted, and bedrooms inspected have lighting and appropriate furnishing. LPA advised facility to contact County Public Health and Community Care Licensing immediately if symptoms of COVID-19 or other infectious diseases are present in the facility. Infection Control Plan and Emergency Disaster Plan were reviewed and found to be appropriate. First Aid kit was inspected and found to be appropriate during the inspection. Emergency Disaster Drill was last conducted in December 2024.

(Report continued on LIC 809C)
Lauren CrockerTELEPHONE: (916) 202-0832
Farhaan SarangiTELEPHONE: (916) 307-0474
DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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, THE
FACILITY NUMBER: 045000700
VISIT DATE: 01/14/2025
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During a review of staff files, LPA identified 1 out of 5 staff members not having the annual training as outlined in regulation (See LIC 9102-Technical Violation). LPA educated the Administrator on the importance of ensuring that training is conducted as outlined in Title 22 regulations. During a resident file review, LPA observed that 2 out of 5 residents did not have an updated LIC 602 (See LIC 9102-Technical Violation). LPA educated the Administrator on the importance of ensuring that the updated LIC 602 is retained in resident files.

LPA requested the following documents to be sent:

LIC 500- Personnel Report
LIC 308- Designation of Facility Responsibility
LIC 309- Administrative Organization
Most up-to-date Liability insurance
Control of Property
Register of residents

No deficiencies were cited during today's Required 1 year inspection. Exit interview was conducted, and a copy of this report was signed and emailed to the Administrator due to printer issues.
SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 202-0832
LICENSING EVALUATOR NAME: Farhaan SarangiTELEPHONE: (916) 307-0474
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025
LIC809 (FAS) - (06/04)
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