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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002984
Report Date: 10/31/2022
Date Signed: 10/31/2022 03:32:34 PM

Document Has Been Signed on 10/31/2022 03:32 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
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:GRANITE MEADOW HOMEFACILITY NUMBER:
315002984
ADMINISTRATOR:SORONGON, ESPERANZAFACILITY TYPE:
734
ADDRESS:3115 GRANITE MEADOWS LNTELEPHONE:
(650) 580-3896
CITY:GRANITE BAYSTATE: CAZIP CODE:
95746
CAPACITY: 5CENSUS: 4DATE:
10/31/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Judee Castro and Espie SorongonTIME COMPLETED:
03:45 PM
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On October 31, 2022 at 2:30 PM Licensing Program Analyst (LPA) Parks arrived to conduct the prelicensing inspection. Prior to the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95.

Due to time constraints, Licensee joined the inspection virtually. LPA, Assistant Administrator and Licensee Espie completed the prelicensing inspection tool domain and the facility was found to be in substantial compliance. LPA, Assistant Administrator, and Licensee conducted a walk through of the facility and ensured all physical plant requirements.

LPA will notify CAB that the facility is ready for licensure.

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: 10/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2022
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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