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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317005526
Report Date: 01/19/2023
Date Signed: 01/23/2023 09:27:53 AM

Document Has Been Signed on 01/23/2023 09:27 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
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:REACH ADULT DEVELOPMENT SITE #4FACILITY NUMBER:
317005526
ADMINISTRATOR:SUH, SEANFACILITY TYPE:
775
ADDRESS:1140 SUNSET BLVD STE 145TELEPHONE:
(916) 616-0729
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY: 30CENSUS: 12DATE:
01/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Orlando Perez, DirectorTIME COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to conduct an annual inspection. LPA met with Director Orlando Perez during today's inspection. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Masks.

LPA toured facility with Director to ensure health and safety of clients in care. LPA toured common areas, kitchen area, and bathrooms. In the areas toured no immediate health, safety, or personal rights violations were observed. Director stated there has been no positive COVID cases at the facility, and sufficient amount of PPE available for staff. There is a locked storage for medications and toxins. LPA reviewed the infection control domain guidance with Director.

No deficiencies are being cited as a result of todays inspection.

Exit interview conducted and copy of report given.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Bethany Mirlohi
LICENSING EVALUATOR SIGNATURE: DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/19/2023
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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