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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045001403
Report Date: 03/12/2022
Date Signed: 03/12/2022 02:23:11 PM

Document Has Been Signed on 03/12/2022 02:23 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:CHRISTAL VIEW CARE HOMEFACILITY NUMBER:
045001403
ADMINISTRATOR:CLARITA DIZONFACILITY TYPE:
735
ADDRESS:3074 GAWTHORNE AVENUETELEPHONE:
(530) 532-6356
CITY:OROVILLESTATE: CAZIP CODE:
95966
CAPACITY: 6CENSUS: 4DATE:
03/12/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Clarita Dizon, AdministratorTIME COMPLETED:
01:15 PM
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On 03/12/2022 Jaclyn Avila, Licensing Program Analyst (LPA) conducted a case management visit to the facility for the purpose of delivering an Order to Individual of Immediate Exclusion from all facilities and the Order to Licensee/Facility of Immediate Exclusion from Facility.

Prior to initiating the visit, 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 ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95

LPA Avila met with the Administrator Clarita Dizon and explained the purpose of today's visit. Bryan Merto, Staff Person is excluded as of this date 03/12/2022, due to his actions related to this facility.

LPA Avila handed the Order to Licensee/Facility of Immediate Exclusion from the Facility and explained that staff person Bryan Merto cannot be allowed to work, be present and/or live in a Community Care Licensing (CCL) licensed facility or have contact with clients in any residential facility or child day care licensed by the California Department of Social Services.

Prior to arriving at the facility, LPA Avila attempted to meet with Bryan Merto but was unable to locate him to serve the Individual of Immediate Exclusion.

A copy of this report was provided to the Administrator via e-mail.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Jaclyn Avila
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2022
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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