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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700963
Report Date: 03/22/2022
Date Signed: 03/22/2022 01:54:02 PM


Document Has Been Signed on 03/22/2022 01:54 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:OARS AT GREENBACK LANE, THEFACILITY NUMBER:
342700963
ADMINISTRATOR:BELL, ORVILLEFACILITY TYPE:
740
ADDRESS:6550 GREENBACK LANETELEPHONE:
(916) 212-0388
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:54CENSUS: 47DATE:
03/22/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Pepper Bell, AdministratorTIME COMPLETED:
02:10 PM
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Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Executive Director, Pepper Bell, to follow-up on incident reports received by the department. Facility currently does not have any COVID-19 positive cases. LPA wore an N-95 mask and was screened by facility upon entry. Facility staff wore masks in the care home.

LPA requested documentation pertinent to the incident reports received by the department, and interviewed Executive Director and Memory Care Director. LPA also obtained contact information for staff to conduct further interviews.

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: 03/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2022
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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