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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 290308074
Report Date: 11/30/2022
Date Signed: 12/23/2022 08:50:33 AM

Document Has Been Signed on 12/23/2022 08:50 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
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:BANNER CRESTFACILITY NUMBER:
290308074
ADMINISTRATOR:LINHARES, JUDITH C.FACILITY TYPE:
740
ADDRESS:12382 CASCADE WAYTELEPHONE:
(530) 272-4513
CITY:NEVADA CITYSTATE: CAZIP CODE:
95959
CAPACITY: 7CENSUS: 6DATE:
11/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Carrie Trammell and Judith LinharesTIME COMPLETED:
04:30 PM
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On 11/30/2022 LPA visited the facility to do an annual review using the Infection Control Portion of the CARES Tool. Prior to entering the facility the LPA had self-screened for COVID symptoms and took my temperature.

LPA toured the facility including common areas, kitchen, bedrooms, hallways, food, PPE, supplies, etc.

LPA reviewed the Infection Control Domain of the CARES Tool with Administrator.

No deficiencies are being cited as a result of todays inspection. Exit interview conducted. A copy of this report was left at the facility.

Exit interview conducted.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Todd Tryon
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2022
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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