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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317005092
Report Date: 10/27/2022
Date Signed: 10/27/2022 01:50:42 PM


Document Has Been Signed on 10/27/2022 01:50 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 CREEKSIDE VILLAFACILITY NUMBER:
317005092
ADMINISTRATOR:LANCASTER, THERESE M.FACILITY TYPE:
740
ADDRESS:695 DAIRY ROADTELEPHONE:
(530) 823-5273
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY:15CENSUS: 13DATE:
10/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Therese and Andrea LancasterTIME COMPLETED:
02:00 PM
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On 10/27/2022 LPA Tryon visited Auburn Creekside Villa to do an annual required visit. LPA met with Therese and Andrea Lancaster. There are currently 13 residents living at the facility.

LPA toured the facility including common areas, kitchen, bedrooms, bathrooms, hallways, storage, yard, etc. The facility appears to have plenty of perishable and non-perishable food supplies, sanitary supplies, cleaners, etc. The facility has plenty of PPE supplies. The house is clean and well-furnished.

LPA reviewed the Infection Control section of the CARES Tool with Licensee and Administrator..
The facility appears to be in substantial compliance at this time.


LPA requested updated copies of Administrator Certificate, control of property, updated 308, updated liability insurance for CCL files.

No deficiencies were cited at today's visit. Exit interview conducted.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2022
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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