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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 297000914
Report Date: 11/14/2022
Date Signed: 11/21/2022 09:23:02 AM

Document Has Been Signed on 11/21/2022 09:23 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:HOUSTON AND NOBLES ADULT RESIDENTIAL CAREFACILITY NUMBER:
297000914
ADMINISTRATOR:MARK & BARBARA HOUSTONFACILITY TYPE:
735
ADDRESS:21706 JOHN BORN ROADTELEPHONE:
(530) 432-3399
CITY:PENN VALLEYSTATE: CAZIP CODE:
95946
CAPACITY: 6CENSUS: 6DATE:
11/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:TIME COMPLETED:
05:00 PM
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LPA Tryon visited the facility to do an annual visit using the Infection control domain of the CARES Tool. LPA met with Administrator Josh Houston.

LPA toured the house including common areas, kitchen, bedrooms, bathrooms, dining area, storage, etc.

There appears to be adequate food supplies, PPE, cleaning supplies, etc.

At this time, the facility appears to be in substantial compliance. No deficiencies were cited at this visit.

Exit interview conducted.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Todd Tryon
LICENSING EVALUATOR SIGNATURE: DATE: 11/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2022
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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