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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045001403
Report Date: 06/07/2023
Date Signed: 06/07/2023 11:08:13 AM

Document Has Been Signed on 06/07/2023 11:08 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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
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: DATE:
06/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:32 AM
MET WITH: Suzie Mulato - care staffTIME COMPLETED:
11:10 AM
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
06/07/2023 9:30 AM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility unannounced to conduct a Required-1 Year inspection. LPA met with care staff Suzie Mulato and explained the purpose of the visit. Licensee Claire Dizon ( #6023551735 exp. 01/09/2025 ) arrived later.

LPA Knight , care staff and the licensee toured the facility together to ensure the health and safety of residents in care. Areas toured include but are not limited to four (4) resident rooms, common areas, two (2) bathrooms, kitchen, storage areas and back yard. Staff and resident files were reviewed. Medications were also reviewed.

Common area was clean and in good repair. All bedrooms had required furniture, bedding, and lighting. Bathrooms were clean and in good repair. Kitchen was clean and in good repair. Facility has required (7) seven-day non-perishable and (2) day perishable supply of food. Medication is locked in a cabinet.

Administrator certificate is current. First aid kit fully stocked and ready for emergency use. Fire extinguishers fully charged and were inspected in September 2022. Smoke detectors are all operational. All employees requiring background checks are cleared. All required postings are displayed within facility.

No pools/bodies of water are on premises. No firearms are on premises. Last disaster drill was conducted in January 2023 which was an earthquake drill the facility has been conducting fire drills every 2 months. In the areas toured no immediate health, safety, or personal rights violations were observed.

No deficiencies are being cited as a result of today’s inspection. Technical assistance was provided.



Exit interview conducted and copy of report was provided to licensee Claire Dizon.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE: DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2023
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 2