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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045002948
Report Date: 10/31/2023
Date Signed: 10/31/2023 12:44:00 PM

Document Has Been Signed on 10/31/2023 12:44 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:WTC NEXUS CHICOFACILITY NUMBER:
045002948
ADMINISTRATOR:DANIELS, ELISEFACILITY TYPE:
775
ADDRESS:2201 PILLSBURY ROAD SUITE 142TELEPHONE:
(530) 343-7994
CITY:CHICOSTATE: CAZIP CODE:
95926
CAPACITY: 44CENSUS: 28DATE:
10/31/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Administrator Elise Daniels TIME COMPLETED:
12:50 PM
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On 10/31/2023, Licensing Program Analyst (LPA) Jaynae Boyles, arrived at the facility unannounced to conduct a 1-Year Required Annual Inspection. LPA met with Facility Administrator, Elise Daniels and explained the purpose of the visit.

LPA Boyles and Administrator toured facility together to ensure health and safety of clients who attend the program. Areas toured include but are not limited to: common areas and common restrooms. LPA observed the facility to be clean, in good repair and odor-free and each bathrooms to have the necessary paper towels and trash can with lids.

LPA observed an activities calendar for the month and daily activities for the clients to participate. The facility was equip with all the necessary supplies to complete the activities the facility has scheduled.

Facility has cleaning supplies and sharps to be locked inaccessible to clients.

Hot water temperature was measured at 118 F. LPA observed four (4) fire extinguishers, fire detectors, and carbon monoxide detectors which were last serviced June of this year.

In the areas toured no immediate health, safety, or personal rights violations were observed.

LPA reviewed a total of five (5) residents' files and five (5) staff files.

Several topics were discussed.

No deficiencies are being cited as a result of today’s inspection.

Exit interview conducted and copy of report left at the facility.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Jaynae Boyles
LICENSING EVALUATOR SIGNATURE: DATE: 10/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2023
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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