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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045002620
Report Date: 10/15/2024
Date Signed: 10/15/2024 04:48:23 PM


Document Has Been Signed on 10/15/2024 04:48 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:WESTMONT OF CHICOFACILITY NUMBER:
045002620
ADMINISTRATOR:KEENE, CLIFFFACILITY TYPE:
740
ADDRESS:2950 SIERRA SUNRISE TERRACETELEPHONE:
(530) 894-5429
CITY:CHICOSTATE: CAZIP CODE:
95928
CAPACITY:99CENSUS: 84DATE:
10/15/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Wendy Anderson - Resident Services DirectorTIME COMPLETED:
05:00 PM
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10/15/2024 04:30 PM Licensing Program Analyst Rebecca Knight conducted an unannounced case management visit and met with Wendy Anderson - Resident Serices Director. The purpose of the visit was for LPA obtain records for 1 resident.

LPA requested the following documents: Admission agreement, LIC602 Physicians Report, care plan, care notes, ADL charting for September through October 2024, incident reports.

No deficiencies were issued as a result of today’s visit. A copy of the report was provided to Wendy Anderson - Resident Services Director.

SUPERVISOR'S NAME: Lauren CrockerTELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 356-2841
LICENSING EVALUATOR SIGNATURE:
DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/15/2024
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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