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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045002577
Report Date: 02/07/2023
Date Signed: 02/07/2023 10:20:52 AM

Document Has Been Signed on 02/07/2023 10:20 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
CCLD Regional Office,
, CA
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:
02/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jenni Richman - AdministratorTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced Required 1 Year Inspection Visit. LPA met with Administrator and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask.

LPA Wallace and administrator 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 Wallace and administrator 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 today's inspection.

Exit interview conducted with administrator and copy of report was provided at facility.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Ruth Wallace
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2023
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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