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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317000174
Report Date: 12/16/2022
Date Signed: 12/20/2022 01:43:01 PM


Document Has Been Signed on 12/20/2022 01:43 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:AUBURN RAVINE TERRACEFACILITY NUMBER:
317000174
ADMINISTRATOR:BILL HUNTFACILITY TYPE:
740
ADDRESS:750 AUBURN RAVINE ROADTELEPHONE:
(530) 823-8339
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY:25CENSUS: 13DATE:
12/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Bill Hunt and Andrea DowlingTIME COMPLETED:
12:30 PM
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On 12/16/2022 LPA Tryon visited the facility to do an annual visit using the Infection Control Domain of the CARES Tool. LPA met with Andrea Dowling, and briefly met with Administrator Bill Hunt.

LPA toured the facility including common areas, dining room, bedrooms, bathrooms, hallways.

LPA reviewed the infection control domain with Ms. Dowling. LPA requested a copy of most recent liability insurance, and current staff schedule.

The facility has completed FIT testing for staff for N-95 masks. The facility has a kit to do future fittings.

The facility appears to be in substantial compliance at this time.

Exit interview conducted
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 12/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/16/2022
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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