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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045002734
Report Date: 11/20/2024
Date Signed: 11/20/2024 12:22:19 PM

Document Has Been Signed on 11/20/2024 12:22 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:INNOVATIONSFACILITY NUMBER:
045002734
ADMINISTRATOR/
DIRECTOR:		GREEN, SEANFACILITY TYPE:
775
ADDRESS:1015 MANGROVE AVETELEPHONE:
(530) 899-1907
CITY:CHICOSTATE: CAZIP CODE:
95926
CAPACITY: 35CENSUS: 18DATE:
11/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:50 AM
MET WITH:Sean Green - Program ManagerTIME VISIT/
INSPECTION COMPLETED:
12:30 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. LPA met with Program Manager 1 Sean Green, and explained the purpose of the visit.

LPA Knight and the program manager toured the facility together to ensure the health and safety of clients who attend program. Areas toured include but are not limited to common areas, two (2) bathrooms, kitchen, and storage areas. Staff and client files were reviewed. All employees requiring background checks are cleared.

There is a schedule of recreational activities planned for the clients and clients are given the choice to go out in the community for activities.

The facility was observed to be at a comfortable temperature. Common area was clean and in good repair. Bathrooms were clean and in good repair. Kitchen was clean and in good repair. Food appears to be stored properly. Fire extinguishers fully charged and inspected. Carbon monoxide detectors are operational. There are no pools/bodies of water are on premises. The facility has been conducting fire drills monthly.

LPA requested the following documents be updated and submitted to LPA to update the facility file: LIC610D Emergency Disaster Plan, LIC500 Personnel Report.

No deficiencies are being cited as a result of todays inspection. Exit interview conducted and copy of report was provided to Program Manager 1 Sean Green.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE: DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/20/2024
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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