<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
045002168
Report Date:
09/18/2023
Date Signed:
09/21/2023 12:48:28 PM
Document Has Been Signed on
09/21/2023 12:48 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
SACRAMENTO NORTH ASC
,
9835 GOETHE ROAD, SUITE 100
SACRAMENTO
,
CA
95827
FACILITY NAME:
FERRER HOME CARE NO. 3
FACILITY NUMBER:
045002168
ADMINISTRATOR:
MABEL, MAXINE
FACILITY TYPE:
735
ADDRESS:
86 ARTESIA DRIVE
TELEPHONE:
(530) 342-9779
CITY:
CHICO
STATE:
CA
ZIP CODE:
95973
CAPACITY:
6
CENSUS:
4
DATE:
09/18/2023
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
02:10 PM
MET WITH:
Administrator Maxine Mabel
TIME COMPLETED:
04:00 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 Boyles and Avila arrived a the facility unannounced to complete an annual inspection. LPAs were unable to complete the annual because of computer issues. LPA could not get into FAS to complete the inspection.
Will return to complete the inspection.
SUPERVISORS NAME
:
Lauren Crocker
LICENSING EVALUATOR NAME
:
Jaynae Boyles
LICENSING EVALUATOR SIGNATURE
:
DATE:
09/18/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/18/2023
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
1