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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700878
Report Date: 12/28/2022
Date Signed: 12/28/2022 02:48:48 PM


Document Has Been Signed on 12/28/2022 02:48 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:SPLENDOR OAKS SENIOR LIVING #3FACILITY NUMBER:
342700878
ADMINISTRATOR:LEE, KEVINFACILITY TYPE:
740
ADDRESS:5813 KENNETH AVETELEPHONE:
(916) 241-9603
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY:12CENSUS: 10DATE:
12/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Ann Williams, Facility ManagerTIME COMPLETED:
03:05 PM
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Licensing Program Analyst (LPA) Michael Hood arrived at the facility unannounced on 12/28/2022 to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with Facility Manager, Ann Williams, 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 mask.

LPA toured the facility to ensure the health and safety of residents in care. Areas toured include but are not limited to: 9 bedrooms and 5 bathrooms for residents, common areas, kitchen, outdoor area, laundry room, garage, and PPE supplies. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Facility Manager completed the infection control domain.

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: Michael HoodTELEPHONE: (916) 531-7341
LICENSING EVALUATOR SIGNATURE:
DATE: 12/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/28/2022
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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