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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045920041
Report Date: 11/05/2024
Date Signed: 11/05/2024 01:30:03 PM

Document Has Been Signed on 11/05/2024 01:30 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/
DIRECTOR:
HOSTESTTER-LEWIS, SCOTTFACILITY TYPE:
775
ADDRESS:2952 ESPLANADE SUITE 100TELEPHONE:
(530) 343-7994
CITY:CHICOSTATE: CAZIP CODE:
95973
CAPACITY: 36CENSUS: 17DATE:
11/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:SCOTT HOSTETTER-LEWISTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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On 11/05/2024 at 11:30 AM Licensing Program Analyst (LPA) Sarah Benson arrived at the facility unannounced to conduct a Required-1 Year inspection. LPA met with Administrator Scott Hostetter-Lewis and Program Manager Elise Daniels explaining the purpose of the visit.

LPA Benson, Administrator and Program Manager toured the facility together to ensure the health and safety of residents in care. Motor vehicles used to transport clients were observed and maintained in safe operating condition. The facility has taken appropriate measures to protect the clients from hazards. Areas toured include but are not limited to common areas, two (2) bathrooms, kitchen, storage areas and yard. In the areas toured no immediate health, safety, or personal rights violations were observed. Staff and resident files were reviewed. Medications were also reviewed. Medication is locked in a locked closet.



The common area was clean, odor-free and in good repair. The bathrooms were clean and in good repair. The kitchen was clean and in good repair. Cooking/dining equipment and utensils were present.

The facility was observed to be at a comfortable temperature. First aid kit fully stocked and ready for emergency use. Fire extinguisher fully charged. Carbon monoxide and smoke detectors are all operational. Hot water temperature measured within required Title 22 regulations of 105 degrees F and 120 degrees F. All employees requiring background checks are cleared. There is a schedule of activities planned for the clients. All required postings are displayed within the facility.
No pools/bodies of water are on the premises. No firearms are on premises. The last disaster drill was conducted and documented on 10-17-24, the facility has been conducting drills every 3 months.

The facility is in compliance. No deficiencies are being cited as a result of today’s inspection.


Exit interview conducted and copy of report was provided to the administrator.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sarah Benson
LICENSING EVALUATOR SIGNATURE: DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2024
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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