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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045002069
Report Date: 12/05/2022
Date Signed: 12/05/2022 11:26:04 AM

Document Has Been Signed on 12/05/2022 11:26 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:CATHY'S CHRISTIAN COTTAGEFACILITY NUMBER:
045002069
ADMINISTRATOR:MATTSON, LUCIFACILITY TYPE:
735
ADDRESS:1136 FRUITVALE ROADTELEPHONE:
(530) 882-4487
CITY:RICHVALESTATE: CAZIP CODE:
95974
CAPACITY: 6CENSUS: 4DATE:
12/05/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Luci MattsonTIME COMPLETED:
11:45 AM
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LPA Parks arrived on Monday December 5, 2022 to conduct the annual inspection. 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: N-95 mask.

LPA and Administrator completed the infection control domain together and facility was found to be in substantial compliance at this time. LPA and Administrator toured facility together to ensure health and safety of clients in care.

No deficiencies are being cited as a result of todays inspection. Exit interview conducted.

A copy of this report was left at the facility.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2022
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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