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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045001798
Report Date: 10/29/2022
Date Signed: 10/29/2022 12:34:19 PM

Document Has Been Signed on 10/29/2022 12:34 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
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:BEDFORD HOUSE, THEFACILITY NUMBER:
045001798
ADMINISTRATOR:COOK, AMYFACILITY TYPE:
735
ADDRESS:1878 BEDFORD DRIVETELEPHONE:
(530) 809-4099
CITY:CHICOSTATE: CAZIP CODE:
95928
CAPACITY: 6CENSUS: 4DATE:
10/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Romelinda "Amy" CookTIME COMPLETED:
12:40 PM
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On 10/29/2022, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a Required 1 year inspection. LPA met with Caregiver, Evelyn Oliveri, who contacted Licensee, Amy, who arrived to the facility shortly afterwards. Prior to 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 she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. LPA observed (2) clients to be eating in the dining room, (1) client to be playing videogames in his private bedroom and (1) client to be sleeping in his private bedroom.

LPA and Licensee toured the interior and exterior of the facility to ensure health and safety of clients in care. Areas toured include but are not limited to: common areas, resident bedrooms, bathroom, kitchen, laundry room and garage. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Licensee followed the infection control domain guidelines and facility was found to be in substantial compliance at this time.

LPA observed the temperature of the facility to be 72*. LPA observed the facility to have 2+ day of perishable and 7+ days of non-perishables for clients in care. LPA observed the facility to have ample supply of PPEs. LPA observed the Administrator Certificate #6007832735 to be up to date with the expiration date of 12/08/2023.

Today's inspection, LPA obtained copies of the LIC 308, Surety Bond and Administrator Certificate.

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

Exit interview conducted and copy of report left at the facility.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 10/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2022
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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