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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045000756
Report Date: 02/08/2023
Date Signed: 02/08/2023 12:39:26 PM

Document Has Been Signed on 02/08/2023 12:39 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,
, CA
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: 38DATE:
02/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Shelley Stephens - AdministratorTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced Required 1 Year Inspection Visit utilizing the infection control domain. LPA met with Administrator and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask.

LPA Wallace and administrator toured facility together to ensure health and safety of clients who attend the day program. Areas toured include but are not limited to: common areas, bathrooms, office, and storage rooms. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA Wallace and administrator completed the infection control domain and facility was found to be in substantial compliance at this time.

Hot water temperature was measured at 109.8 degrees Fahrenheit in resident bathroom sink, which is within the required regulation of 105 to 120 degrees Fahrenheit. Fire extinguishers were last inspected on 9/19/2022. Smoke and carbon monoxide detectors are in compliance with fire safety. Thermostat observed at (73.6) degrees Fahrenheit. LPA reviewed four (4) client records and four (4) staff records. All documents were complete and staff have current first aid certificates.

No deficiencies are being cited as a result of today's inspection.

Exit interview conducted and copy of report was provided to administrator at facility.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Ruth Wallace
LICENSING EVALUATOR SIGNATURE: DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/08/2023
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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