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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 297004085
Report Date: 03/21/2023
Date Signed: 03/21/2023 02:57:16 PM

Document Has Been Signed on 03/21/2023 02:57 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
, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:YOUNGER'S RESIDENTIAL CAREFACILITY NUMBER:
297004085
ADMINISTRATOR:YOUNGER, SHARIFACILITY TYPE:
735
ADDRESS:10820 CONIFER LANETELEPHONE:
(530) 273-7765
CITY:GRASS VALLEYSTATE: CAZIP CODE:
95945
CAPACITY: 6CENSUS: 5DATE:
03/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Shari YoungerTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Melissa Parks arrived on Tuesday March 21, 2023 to conduct the annual inspection. LPA wore a N95 mask during todays visit.

During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA Parks reviewed client (5) and staff (2) files. All resident files contained the required paperwork. All staff files contained the required paperwork and training.

LPA Parks and Shari toured the facility together to ensure the health and safety of clients in care. The areas toured included bedrooms, kitchen, bathrooms, and garage. Water temperatures in the kitchen and bathrooms were within the required range of temperature. In the areas toured, there were no health or safety violations observed.

No deficiencies cited. Exit interview conducted. A copy of this report was left at the facility.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE: DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2023
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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