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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045000756
Report Date: 01/18/2024
Date Signed: 01/18/2024 10:55:24 AM

Document Has Been Signed on 01/18/2024 10:55 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: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: 35DATE:
01/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:49 AM
MET WITH:Associate Director- Shelly Stephans TIME COMPLETED:
11:00 AM
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On 1/18/2024 Licensing Program Analyst (LPA) Jaynae Boyles arrived at the facility unannounced to conduct a Required Year Inspection.

LPA conducted an inspection of the Adult Day Program to ensure compliance with Title 22 regulations.

There are three three class rooms, one quiet room and one large room for activities for participants to use. These rooms are utilized as, music room, computer room and a game room. Each classroom had a plethora of supplies for activities for the classrooms. The bathrooms were in sanitary condition, properly maintained, and the hot water temperature was observed to be 111.6 degrees F.

LPA checked the kitchen area for the ability to prepare and store food. LPA observed knives, cleaning products and other toxins to be locked away and inaccessible to participants. LPA observed the outdoor area and perimeter of the Adult Day Program to be free of clutter and debris and there appeared to be no potential safety hazards to the participants. Smoke detectors and carbon monoxide detector are operational. Fire extinguisher and first aid kit are maintained and ready for emergency use.

LPA checked medication storage and found medication to be locked away and inaccessible to the participants. LPA reviewed (6) resident files and also reviewed five (5) staff files which contained all the required documentation.

As a result of this visit, no deficiencies were cited per California Code of Regulations, Title 22. Exit interview conducted and copy of report given at the conclusion of this visit.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Jaynae Boyles
LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2024
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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