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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045000756
Report Date: 01/14/2025
Date Signed: 01/14/2025 10:54:58 AM

Document Has Been Signed on 01/14/2025 10:54 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/
DIRECTOR:		STEPHENS, SHELLEYFACILITY TYPE:
775
ADDRESS:2040 PARK AVETELEPHONE:
(530) 891-5865
CITY:CHICOSTATE: CAZIP CODE:
95928
CAPACITY: 90CENSUS: 21DATE:
01/14/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Administrators, Shelly Stephens and Sarah SilvaTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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On January 14, 2025 at approximately 8:30 AM, Licensing Program Analysts (LPAs), Farhaan Sarangi and Kayla Adkison arrived unannounced at Arc of Butte County, The for the purpose of conducting a Required 1 year inspection. LPAs ware greeted at the door by Administrators, Shelly Stephens and Sarah Silva. A random sample of clients were interviewed during the Required 1 year inspection.

LPAs and the Administrators toured the facility. LPAs observed the facility was found to be clean and at a comfortable temperature with all exits free from obstruction. LPAs observed a main area where clients do activities, an back room area, isolation room, lockers for clients in care, toxin locker where toxins are stored and an isolation room. LPAs observed an shaded outdoor activity space. Fire Extinguishers were found to be last charged on September 2024 at the time of the inspection. All smoke detectors sound directly to the local fire jurisdiction. Carbon Monoxide Detector were tested and found to be operational. 1 of 1 bathroom water temperature was tested and measured at 105 degrees and is within regulation of 105-120 degrees. Facility does not prepare food for clients as clients bring their own lunches. Medications were centrally stored and locked. Cleaning products and other toxins are locked and inaccessible to clients in care. There was a supply of cleaners, hygiene products and paper products available for clients and/or staff. All bathrooms designated for clients in the common areas at the facility were supplied with individual paper towels and hand soap. 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. LPA reviewed the Emergency Disaster Plan and the Infection Control Plan and found those documents to be appropriate during the inspection. Infection Control Plan will be updated and sent to CCL. Emergency Disaster Drill was conducted in last December 2024.

(Report continued on LIC 809C)
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Farhaan Sarangi
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
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: ARC OF BUTTE COUNTY, THE
FACILITY NUMBER: 045000756
VISIT DATE: 01/14/2025
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LPA reviewed 3 staff files and found those to be appropriate during the review. Staff that provide Care and Supervision have valid First Aid/CPR. First Aid kit was inspected and found to be appropriate during the inspection. 5 of 5 client records were reviewed and found to be appropriate during the review. LPAs reviewed the Medication Orders and found that facility did not retain Medication Orders for 1 out of 5 clients in care (See LIC 9102-Technical Violation). LPA educated the Administrator on the importance of ensuring that ALL medication orders are retained in client 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 clients
Updated Infection Control Plan

No deficiencies were cited during today's Required 1 year inspection. Exit interview was conducted and a copy of this report was emailed to the facility Administrator due to printer issues.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Farhaan Sarangi
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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