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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 092700214
Report Date: 07/22/2022
Date Signed: 07/22/2022 01:25:48 PM

Document Has Been Signed on 07/22/2022 01:25 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:WILSON HOME, THEFACILITY NUMBER:
092700214
ADMINISTRATOR:JESSICCA WILSONFACILITY TYPE:
735
ADDRESS:4310 OAK VIEW DRIVETELEPHONE:
(530) 363-2631
CITY:PILOT HILLSTATE: CAZIP CODE:
95664
CAPACITY: 6CENSUS: 4DATE:
07/22/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Jessicca and Elliott WilsonTIME COMPLETED:
02:00 PM
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On 7/22/2022 LPA Tryon and LPM Maribeth Senty met with the facility licensees by video meeting. The licensees were at their new "vacation" home in Maui, Hawaii. The purpose of the meeting was to do a video "walk-through" of the Maui house to do an inspection and to make sure that it is an appropriate and safe environment for clients, ensures privacy, meets resident needs, etc.

We met with Elliott and Jessicca Wilson. Elliott walked us through the house on video, where we viewed 2 resident bedrooms that are each shared by 2 residents, staff room, bathroom, living/dining area, kitchen, large outside decks, food and medication storage. The house is equipped with smoke detectors and fire extinguisher. They have games and various activities available for residents, but usually spend a lot of time visiting local beaches and parks.

According to the Wilsons the local area is very conscious of COVID precautions, and many people still wear masks when they go out and are very cautious. The number of COVID cases is apparently very low in the area at the moment.

The home appears to be appropriate to meet the needs of the residents and staff, and the residents are being kept busy with fun activities.

The plan is to return to California on September 8, 2022.

At this time there appear to be no issues. No deficiencies cited at this visit. Exit interview conducted. This document will be forwarded to the facility via e-mail. LPA asked that Administrator sign and send the document back when they get it.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Todd Tryon
LICENSING EVALUATOR SIGNATURE: DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2022
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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