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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045920041
Report Date: 11/30/2023
Date Signed: 11/30/2023 01:21:11 PM

Document Has Been Signed on 11/30/2023 01:21 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 MOSAIC CHICOFACILITY NUMBER:
045920041
ADMINISTRATOR:HOSTESTTER-LEWIS, SCOTTFACILITY TYPE:
775
ADDRESS:2952 ESPLANADE SUITE 100TELEPHONE:
(530) 343-7994
CITY:CHICOSTATE: CAZIP CODE:
95973
CAPACITY: 36CENSUS: 0DATE:
11/30/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:53 PM
MET WITH:Administrator- Andrea MoriartyTIME COMPLETED:
01:30 PM
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On 11/30/2023 Licensing Program Analyst (LPA) Jaynae Boyles met with the Administrator Andrea Moriarty
to conduct a Pre-licensing visit. There are currently no participants.

LPA conducted an inspection of the Adult Day Program to ensure compliance with Title 22 regulations. There are four (4) classrooms and two (2) bathrooms for participant use. LPA observed facility to be properly furnished. Bathrooms were in sanitary condition and properly maintained.

LPA checked the kitchen area for the ability to prepare and store food. LPA observed cleaning products and other toxins to be locked away. LPA observed the area used for medication to be locked and inaccessible to residents. LPA observed smoke detectors and carbon monoxide detectors to be operational. Fire extinguisher and first aid kit are maintained and ready for emergency use.

Pre-licensing passed and the Component III is wavied, as this is one three day programs with this agency. Applicant has satisfied all requirements in accordance to Title 22, California Code of Regulations. Application is pending and LPA will forward findings to the Centralized Application Bureau (CAB) for final review and approval. CAB will further contact applicant on final status of application.

Several topics were discussed.

Exit interview conducted and a copy of this report was provided to the facility.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Jaynae Boyles
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2023
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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