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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045002734
Report Date: 02/07/2023
Date Signed: 02/07/2023 01:03:54 PM

Document Has Been Signed on 02/07/2023 01:03 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:INNOVATIONSFACILITY NUMBER:
045002734
ADMINISTRATOR:GREEN, SEANFACILITY TYPE:
775
ADDRESS:1015 MANGROVE AVETELEPHONE:
(530) 723-2900
CITY:CHICOSTATE: CAZIP CODE:
95926
CAPACITY: 35CENSUS: DATE:
02/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Sean Green - Program Manager 2TIME COMPLETED:
01:00 PM
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02/07/2023 12:15 PM 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 2 Sean Green, 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: N-95 Mask and gloves. Additionally LPA was screened by facility staff.

LPA Knight and Mr. Green 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, bathrooms, and storage areas. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA Knight and Mr. Green 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 Program Manager 2 Sean Green.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
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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