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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
317002200
Report Date:
02/02/2023
Date Signed:
02/02/2023 03:43:26 PM
Document Has Been Signed on
02/02/2023 03:43 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:
YOUNG'S CARE HOME
FACILITY NUMBER:
317002200
ADMINISTRATOR:
DENISE YOUNG
FACILITY TYPE:
735
ADDRESS:
24295 MILK RANCH ROAD
TELEPHONE:
(530) 346-7482
CITY:
COLFAX
STATE:
CA
ZIP CODE:
95713
CAPACITY:
6
CENSUS:
5
DATE:
02/02/2023
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
03:00 PM
MET WITH:
Denise Young
TIME COMPLETED:
04:00 PM
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On 2/2/2023 LPA Tryon visited the facility to amend a 9099 Complaint Investigation Report dated 11/16/2023. LPA screened for COVID before entering the facility.
LPA amended document 9099 dated 11/16/2023 to make the status PUBLIC rather than CONFIDENTIAL.
Exit interview conducted.
SUPERVISORS NAME
:
Troy Ordonez
LICENSING EVALUATOR NAME
:
Todd Tryon
LICENSING EVALUATOR SIGNATURE
:
DATE:
02/02/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
02/02/2023
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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