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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045000789
Report Date: 04/14/2022
Date Signed: 04/14/2022 12:08:20 PM

Document Has Been Signed on 04/14/2022 12:08 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:HIGHLAND VIEW CARE HOMEFACILITY NUMBER:
045000789
ADMINISTRATOR:SERRANO,NORA CHAVEZFACILITY TYPE:
735
ADDRESS:62 HIGHLANDS BLVD.TELEPHONE:
(530) 533-3079
CITY:OROVILLESTATE: CAZIP CODE:
95966
CAPACITY: 6CENSUS: 3DATE:
04/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:16 PM
MET WITH:Virginia Moebs, House ManagerTIME COMPLETED:
01:45 PM
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04/14/2022 12:15 p.m., Licensing Program Analyst (LPA) Dawn Keane , arrived at the facility unannounced to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with House Manager (HM), Virginia Moebs and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA contacted HM and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA Keane was screened by staff member. Licensee Nora Serrano was present at the meeting.

LPA Keane and HM toured facility to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, two (2) bathrooms, four (4) bedrooms, kitchen, storage areas. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA Keane completed the infection control domain and facility was found to be in substantial compliance at this time.

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

Exit interview conducted and copy of report was given to HM.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Dawn Keane
LICENSING EVALUATOR SIGNATURE: DATE: 04/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/14/2022
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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