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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 295002880
Report Date: 01/18/2022
Date Signed: 01/18/2022 12:35:37 PM

Document Has Been Signed on 01/18/2022 12:35 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:ODYSSEY HOUSEFACILITY NUMBER:
295002880
ADMINISTRATOR:PHENIX, DIANE LCSWFACILITY TYPE:
772
ADDRESS:995 HELLING WAYTELEPHONE:
(530) 265-7222
CITY:NEVADA CITYSTATE: CAZIP CODE:
95959
CAPACITY: 16CENSUS: 0DATE:
01/18/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Diane PhenixTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Jacob Williams met with applicant, Diane Phenix, to conduct a Pre- Licensing visit. The facility has a fire clearance for 16 ambulatory clients. Facility will be relocating from temporary facility now that remodel of this location is complete.

LPA conducted an inspection of the social rehabilitation facility (SRF) to ensure compliance with Title 22 regulations. There are eight (8) bedrooms and two (2) bathrooms (including four total stalls and four total showers) for resident use, along with one (1) bathroom for staff. LPA observed facility to be properly furnished, including appropriate lighting. Bathrooms were in sanitary condition and properly maintained. Hot water temperature was observed to be 120 degrees F.

LPA checked the kitchen area for the ability to prepare and store food. LPA observed at least a 7-day nonperishable food supply at the facility. LPAs observed cleaning products and other toxins to be locked away. LPAs observed the area used for medication to be locked and inaccessible to clients. LPA observed smoke detectors and carbon monoxide detectors at the SRF are operational. Fire extinguisher is maintained.

First aid kit is not on location, as it has not been brought over from temporary location yet; LPA requesting proof of first aid kit within 7 days (by 1/25/2022). Resident files and staff files still not brought over from temporary location, so LPA could not review (LPA confirmed with manager this is okay). Note: administrator's certificate not required for Program Director of social rehabilitation facility.

Pre-licensing passed and Component III waived. Applicant has satisfied all requirements in accordance to Title 22, California Code of Regulations. Application is pending and LPA will forward findings to the Centralized Application Bureau (CAB) for final review and approval. CAB will further contact applicant on final status of application. A copy of this report was provided to the facility. Exit interview conducted.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Jacob Williams
LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2022
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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