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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317002200
Report Date: 11/16/2022
Date Signed: 11/16/2022 04:41:00 PM

Document Has Been Signed on 11/16/2022 04:41 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:YOUNG'S CARE HOMEFACILITY NUMBER:
317002200
ADMINISTRATOR:DENISE YOUNGFACILITY TYPE:
735
ADDRESS:24295 MILK RANCH ROADTELEPHONE:
(530) 346-7482
CITY:COLFAXSTATE: CAZIP CODE:
95713
CAPACITY: 6CENSUS: 5DATE:
11/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Denise YoungTIME COMPLETED:
01:00 PM
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LPA visited the facility on 11/16/2022 to conduct an annual visit using the infection control domain of the CARES Tool.

LPA toured the facility including common areas, kitchen, bedrooms, bathrooms, storage, yard. Facility appears to have adequate supplies of food, cleaning supplies, PPE, etc.

The home is clean, freshly painted, well-furnished and pleasant.

LPA reviewed the Infection Control Section of the CARES Tool.

At this time, the facility appears to be in substantial compliance with regulations. No deficiencies were cited at this visit. Exit interview conducted.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Todd Tryon
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2022
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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