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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700471
Report Date: 02/10/2023
Date Signed: 02/10/2023 12:05:27 PM


Document Has Been Signed on 02/10/2023 12:05 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:COGIR OF STOCK RANCHFACILITY NUMBER:
342700471
ADMINISTRATOR:DAVID JR., RICKYFACILITY TYPE:
740
ADDRESS:7418 STOCK RANCH RDTELEPHONE:
(916) 725-7418
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:99CENSUS: 56DATE:
02/10/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Executive Director: Ricky David TIME COMPLETED:
12:10 PM
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Licensing Program Analyst (LPA) arrived at the facility unannounced on 02/10/2023 to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with Executive Director, Ricky David, and explained the purpose of the visit. LPA ensured to apply hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Masks. LPA were screened by facility staff prior to entering the facility.

LPAs toured the facility to ensure the health and safety of residents in care. Areas toured include but are not limited to: first and second floor of Assisted Living Unit, four (4) residents bedroom, five (5) bathrooms, dining room, kitchen, and stairwells. Stairwells have evacuation chairs. In the areas toured no immediate health, safety, or personal rights violations were observed. LPAs and Executive Director completed the infection control domain and facility was found to be in substantial compliance at this time. LPA provided ED summary of PIN 23-02-ASC -UPDATED GUIDANCE ON TESTING, ISOLATION AND QUARANTINE.

No deficiencies are being cited. Exit interview conducted and copy of report left at the facility.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Sarena KeosavangTELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:
DATE: 02/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/10/2023
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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