<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002934
Report Date: 01/30/2023
Date Signed: 01/31/2023 11:25:57 AM


Document Has Been Signed on 01/31/2023 11:25 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:AUBURN GLEN SENIOR LIVINGFACILITY NUMBER:
315002934
ADMINISTRATOR:DOWLING, ANDREAFACILITY TYPE:
740
ADDRESS:750 AUBURN RAVINE ROADTELEPHONE:
(530) 823-6131
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY:25CENSUS: 12DATE:
01/30/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:08 PM
MET WITH:Bill Hunt, Andrea DowlingTIME COMPLETED:
03:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On January 30, 2023 LPA Tryon and LPA Ayers arrived at the facility unannounced to do a pre-licensing visit. . LPAs met with Administrators Bill Hunt and Andrea Dowling.
LPAs toured the facility including common areas, resident rooms, hallways, medication room, kitchen, dining room, outside, etc.

The facility appears to be clean and in good condition. The facility shares the kitchen with the Skilled Area on other floors. The kitchen is well-equipped, clean and has large supply of perishable and non-perishable food. Coolers/freezers were at appropriate temperatures. Hot water was tested at resident room and was at 110 Degrees F, within the appropriate range of 105 to 120 degrees F.

LPAs reviewed the pre-licensing version of the CARE Tool with Administrators.

The facility appears to be in substantial compliance with regulations. No deficiencies were noted at this visit.

The Component III of the RCFE Orientation is waived at this time, as the Administrators have been Administrators for multiple years each.

Report will be forwarded to the Central Application Unit to complete the application process.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 01/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/30/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1