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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045920058
Report Date: 09/08/2023
Date Signed: 09/08/2023 11:49:28 AM

Document Has Been Signed on 09/08/2023 11:49 AM - 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:LOWELL HOUSEFACILITY NUMBER:
045920058
ADMINISTRATOR:MCNAMAR, SIRBRINAFACILITY TYPE:
735
ADDRESS:1296 ARCH WAYTELEPHONE:
(530) 321-0262
CITY:CHICOSTATE: CAZIP CODE:
95973
CAPACITY: 4CENSUS: 0DATE:
09/08/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:04 AM
MET WITH:Administrator Sirbrina McnamarTIME COMPLETED:
12:00 PM
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On 09/08/2023, Licensing Program Analyst (LPA) Jaynae Boyles arrived at the facility announced to conduct a Pre licensing Inspection. LPA met with Facility Administrator, Sirbrina Mcnamar and explained the purpose of the visit.

LPA Boyles and Administrator Mcnamar toured facility together to ensure that the facility is in compliance for an Adult Residential Facility. Areas toured include but are not limited to: common areas, four bedrooms, garage, backyard, and two restrooms. LPA observed the facility to be clean, in good repair and odor-free.

The facility was equip with required fire extinguishers, fire detectors and carbon monoxide detectors.

Several topics were discussed.



Component III orientation was waived due to this being a change of location.

This facility meets regulations. LPA is going to submit this report to the application specialist.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Jaynae Boyles
LICENSING EVALUATOR SIGNATURE: DATE: 09/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2023
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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