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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045000756
Report Date: 02/22/2022
Date Signed: 02/22/2022 01:26:18 PM

Document Has Been Signed on 02/22/2022 01:26 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:ARC OF BUTTE COUNTY, THEFACILITY NUMBER:
045000756
ADMINISTRATOR:STEPHENS, SHELLEYFACILITY TYPE:
775
ADDRESS:2040 PARK AVETELEPHONE:
(530) 891-5865
CITY:CHICOSTATE: CAZIP CODE:
95928
CAPACITY: 90CENSUS: 25DATE:
02/22/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Nelson CorwinTIME COMPLETED:
01:15 PM
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On 2/22/2022, Licensing Program Analyst (LPA) Jaclyn Avila conducted an unannounced case management visit. The purpose of the visit is was to conduct interviews regarding a complaint at a licensed care home.

LPA spoke with staff regarding mandated reporting and went over 82061 CCR title 22 with Nelson Corwin Assistant Director. LPA requested the facility conduct a training on mandated reporting with all staff so that they know when and to who they need to report to.

No citations issued at today's visit.
SUPERVISORS NAME: Rayna L Bryson
LICENSING EVALUATOR NAME: Jaclyn Avila
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2022
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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