<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045001341
Report Date: 11/30/2022
Date Signed: 11/30/2022 11:51:58 AM

Document Has Been Signed on 11/30/2022 11:51 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
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:GRIDLEY ADULT SERVICES PROGRAMFACILITY NUMBER:
045001341
ADMINISTRATOR:CHERYL CHILDERSFACILITY TYPE:
775
ADDRESS:262 LITTLE AVENUETELEPHONE:
(530) 846-4988
CITY:GRIDLEYSTATE: CAZIP CODE:
95948
CAPACITY: 25CENSUS: 18DATE:
11/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Cheryl ChildersTIME COMPLETED:
12:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
LPA Hiratsuka, conducted this unannounced annual visit. LPA wore a surgical mask and observed all staff wore masks during visit.

The main entrance opens to a foyer. To the left of the main entrance leads to two common areas which the larger one has a sliding door to the outside, one full client bathroom, one full staff bathroom, and one office. To the right of the main entrance is the kitchen, a small common room, laundry room, a common half bathroom, and the laundry room has a door leading to the garage. In front of the main entrance is a brick fire place that is blocked off and on the other side of the fire place is another common area. The backyard has a fenced in pool that has a locked gate, a pool house used for storage and has a common bathroom, and further back in the yard is a covered area. The backyard also has a paved area for parking.

Multiple topics were discussed during visit.

No deficiencies cited.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1