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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045002726
Report Date: 01/27/2023
Date Signed: 01/27/2023 12:47:56 PM

Document Has Been Signed on 01/27/2023 12:47 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:PHOENIX HOUSEFACILITY NUMBER:
045002726
ADMINISTRATOR:DAVIDSON, WILLIAMFACILITY TYPE:
735
ADDRESS:43 MEADOWVIEW DRIVETELEPHONE:
(530) 353-3870
CITY:OROVILLESTATE: CAZIP CODE:
95966
CAPACITY: 4CENSUS: 4DATE:
01/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:58 AM
MET WITH:Renee Rhodes - administratorTIME COMPLETED:
12:00 PM
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01/27/2023 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 administrator Renee Rhodes and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed 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: N95 Mask, gloves. Additionally, LPA Knight was screened on entrance to the facility.

LPA Knight and Renee Rhodes toured facility together to ensure health and safety of clients in care. Areas toured include but are not limited to: common areas, four (4) client bedrooms, two (2) bathrooms, kitchen, storage areas and back yard. In the areas toured no immediate health, safety, or personal rights violations were observed .LPA interviewed 2 staff during the visit. LPA Knight and the 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 todays inspection.

Exit interview conducted and copy of report was provided to administrator Renee Rhodes
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE: DATE: 01/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/27/2023
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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