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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045002390
Report Date: 09/07/2022
Date Signed: 09/07/2022 01:22:45 PM


Document Has Been Signed on 09/07/2022 01:22 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:SUNSHINE ASSISTED LIVING-THE HOUSEFACILITY NUMBER:
045002390
ADMINISTRATOR:KREPELKA, LARRYFACILITY TYPE:
740
ADDRESS:1463 E. DOTTIE LANETELEPHONE:
(530) 872-0375
CITY:PARADISESTATE: CAZIP CODE:
95969
CAPACITY:15CENSUS: 0DATE:
09/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:18 PM
MET WITH:Larry KrepelkaTIME COMPLETED:
01:35 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
On 09/07/2022 at 11:40 AM Licensing Program Analyst (LPA) Jaclyn Avila arrived at the facility unannounced to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with licensee Larry Krepelka and explained the purpose of the visit. Prior to initiating the annual inspection, 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. Personal Protective Equipment (PPE) was worn: N-95 Mask


The facility was damaged during the Camp Fire in 2018 and is currently going through renovations. The facility does not have residents in care. The licensee has chosen to keep the license active in the event he is able to complete the renovation of the facility. The infection control domain is not applicable at this time.

Exit interview conducted and copy of report will be emailed to licensee Larry Krepelka.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Jaclyn AvilaTELEPHONE: (530) 341-4932
LICENSING EVALUATOR SIGNATURE:
DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/07/2022
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