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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002804
Report Date: 11/09/2022
Date Signed: 11/09/2022 02:54:56 PM

Document Has Been Signed on 11/09/2022 02:54 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
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:ODYSSEY LIFE CENTERFACILITY NUMBER:
345002804
ADMINISTRATOR:PENMAN, SHELBYFACILITY TYPE:
775
ADDRESS:283 IRON POINTTELEPHONE:
(916) 988-0258
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY: 30CENSUS: 28DATE:
11/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:29 PM
MET WITH:Juanaila Ryan Psych Coordinator TIME COMPLETED:
03:30 PM
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On 11/09/2022 at 2:30 PM, Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with Psych Coordinator, Juanaila Ryan, and explained the purpose of the visit.

LPA toured the facility together with Psych Coordinator to ensure health and safety of clients in care. Areas toured include by are not limited to: common areas and two (2) bathrooms. In the areas toured no immediate health, safety, or person rights violations were observed. LPA and Psych Coordinator completed the infection control domain and facility was found to be in substantial compliance at this time.

No deficiencies are being cited as a result of today's inspection.

Exit interview conducted and report left at the facility.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Sarena Keosavang
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2022
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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