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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317000780
Report Date: 08/22/2022
Date Signed: 08/22/2022 04:38:14 PM


Document Has Been Signed on 08/22/2022 04:38 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:GLADDING RIDGEFACILITY NUMBER:
317000780
ADMINISTRATOR:KRISTINE REYMONTFACILITY TYPE:
740
ADDRESS:1660 THIRD STREETTELEPHONE:
(916) 645-0106
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY:99CENSUS: 49DATE:
08/22/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Kristine ReymontTIME COMPLETED:
03:30 PM
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LPA Parks arrived on Monday August 22, 2022 to follow up on an incident report received by the Department on 8/12/2022. 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 mask.

LPA discussed R1 with Administrator Kristine. LPA received copies of R1's physicians report and care plan. R1 is currently at a SNF and not at the facility.

No deficiencies are being cited. Exit interview conducted A copy of this report was left at the facility.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Melissa ParksTELEPHONE: (559) 580-5423
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2022
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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