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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 095002890
Report Date: 04/19/2022
Date Signed: 04/19/2022 02:37:58 PM

Document Has Been Signed on 04/19/2022 02:37 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:COMPASSION SPRINGS SRFFACILITY NUMBER:
095002890
ADMINISTRATOR:EZEANI, IFEANYIFACILITY TYPE:
772
ADDRESS:4229 TOYAN WAYTELEPHONE:
(916) 870-9676
CITY:DIAMOND SPRINGSSTATE: CAZIP CODE:
95619
CAPACITY: 6CENSUS: 0DATE:
04/19/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Ifeanyi EzeaniTIME COMPLETED:
02:45 PM
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Pre-licensing visit conducted today by Michael Smith LPA and licensee/administrator Ifeanyi Ezeani. There are no residents. Facility was granted fire clearance on 3/10/22 for a total of 6 residents, in which 6 can be ambulatory adults. Facility will serve 6 social rehabilitation, mental health adult residents ages 18-59. Administrator’s certificate expires on 7/20/23.

Facility was inspected both indoors and outdoors. Outdoors was clean, tidy with adequate shading. Indoors has the requisite rooms for activity/den/dining. There are locked cabinets for personnel and client records. Facility has a First Aid kit and centrally stored locked cabinet for medication. Water faucets are marked hot and cold with the hot water temperature at 119'. Smoke detectors were present. Fire extinguisher indicator revealed a full charge. Toxins and chemicals are appropriately locked in a cabinet. No hazardous debris noted.

All adults ages 18+ who reside here and are not clients, and all staff shall be fingerprinted and pass a criminal background check, prior to being present at the facility.

Licensee completed Component II on 3/7/22. Component III is being waived as the licensee has another facility, Garfield Wellness & Recovery LIC #342700698.

Items that need to be addressed prior to a report being forwarded to Centralized Application Bureau and will necessitate another pre-licensing visit:
1) Operational washer and dryer needs to be present in the facility
2) Cabinets in the bedrooms are not fully functional and needs to be built and completed.
3) The sliding door in the master bedroom is permanently closed needs to be cleared by the Fire Department.
4) Extra linens needs to be on site. Blankets / Comforters / Towels / Washcloths are needed.
5) Non-perishable foods need to be stocked.
6) Chairs and reading lamps are needed in the client bedrooms.
7) Trash can with lid for the kitchen.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Michael Smith
LICENSING EVALUATOR SIGNATURE: DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/19/2022
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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