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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045002509
Report Date: 10/30/2022
Date Signed: 10/30/2022 01:05:12 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 10/30/2022 01:05 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:GOLDEN SIERRA CAREHOME INCFACILITY NUMBER:
045002509
ADMINISTRATOR:QUIAMBAO, EDGARDO C.FACILITY TYPE:
740
ADDRESS:2289 BAR TRIANGLE STREETTELEPHONE:
(530) 774-7929
CITY:CHICOSTATE: CAZIP CODE:
95928
CAPACITY:6CENSUS: 0DATE:
10/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Aaron MurilloTIME COMPLETED:
01:15 PM
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On 10/30/2022, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a Required 1-yr annual inspection. LPA met with Aaron Murillo, and explained the purpose of the visit. LPA was informed by Aaron that there are no residents at the facility as Licensee, Edgardo Quiambao, has sold the property to Aaron Murillo.

LPA contacted Licensee and informed LPA that documents and notifications were emailed to LPA Avila. LPA requested for the emails to be forwarded to her. Licensee informed LPA that license will be open until the new licensee submits all documents to CAB. Licensee informed LPA that a new lease agreement was provided to CCLD but it will be re-submitted to LPA.

At this time, no deficiencies were observed.

Exit interview conducted and a copy of the report is left at the facility.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 10/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/30/2022
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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