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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317004933
Report Date: 03/24/2022
Date Signed: 03/25/2022 09:42:58 AM


Document Has Been Signed on 03/25/2022 09:42 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:OUTLOOK SENIOR CARE LLCFACILITY NUMBER:
317004933
ADMINISTRATOR:MIHALAS, DORICAFACILITY TYPE:
740
ADDRESS:805 MO COURTTELEPHONE:
(916) 541-7789
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY:6CENSUS: 6DATE:
03/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Calin MihalasTIME COMPLETED:
12:00 PM
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On 3/24/2022 LPA Tryon visited the facility to do an annual inspection using the Infection Control domain of the CARES Tool. LPA had self-screened for COVID symptoms prior to arriving at the facility. LPA was again screened upon arrival at the facility. LPA wore a surgical mask and used hand sanitizer. LPA met with Administrator Calin Mihalas..

LPA toured the facility including common areas, kitchen, bedrooms, bathrooms, hallways, patio, yard.

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

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) 208-7709
LICENSING EVALUATOR SIGNATURE:
DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2022
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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