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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045002577
Report Date: 12/09/2021
Date Signed: 05/24/2022 03:01:07 PM

Document Has Been Signed on 05/24/2022 03:01 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:SOARFACILITY NUMBER:
045002577
ADMINISTRATOR:YOKOTA, YULIKOFACILITY TYPE:
775
ADDRESS:3760 MORROW LN STE FTELEPHONE:
(530) 898-0813
CITY:CHICOSTATE: CAZIP CODE:
95928
CAPACITY: 6CENSUS: 0DATE:
12/09/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Jenny Porter - Program ManagerTIME COMPLETED:
12:00 PM
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12/09/2021 11:00 AM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility unannounced to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with Program Manager Jenny Corwin, 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; LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 Mask and gloves.

LPA Knight and Ms. Porter toured facility together to ensure health and safety of clients who attend the day program. Areas toured include but are not limited to: common areas, bathroom, and kitchen. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA Knight and Ms Porter completed the infection control domain and facility was found to be in substantial compliance at this time.

No deficiencies are being cited as a result of todays inspection. Technical Assistance was provided.

Exit interview conducted and copy of report was emailed to Program Manager Jenny Porter.
SUPERVISORS NAME: Rayna L Bryson
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE: DATE: 12/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2021
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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