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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700243
Report Date: 07/13/2021
Date Signed: 07/15/2021 09:21:17 AM

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:CHAUPPETTE ASSISTED LIVING LLCFACILITY NUMBER:
342700243
ADMINISTRATOR:CHAUPPETTE, SHEREEFACILITY TYPE:
740
ADDRESS:6813 MARINVALE DRIVETELEPHONE:
(916) 560-8708
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:6CENSUS: 5DATE:
07/13/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Angie ChavezTIME COMPLETED:
04:30 PM
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On 7/13/2021 LPA Tryon visited the facility to follow up on an eviction notice given to resident R1 dated 5/26/21 and revised on 6/2/2021. The reason for the eviction notice was not following house rules, related to family members encouraging the facility to take actions that are against regulation; and the facility believed that the resident had needs that were higher than the facility was set up to provide.

At this time, R1 is still living at the facility; and hospice services have been started for her.
It appears that the new plan in place between the home and the hospice agency is working okay for the resident at this time. The hospice agency is working closely with the home and resident needs are being met.

No deficiencies are being cited at this visit.

Exit interview conducted.


SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 208-7709
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2021
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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