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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002871
Report Date: 12/10/2021
Date Signed: 12/10/2021 10:25:43 AM

Document Has Been Signed on 12/10/2021 10:25 AM - 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:CADWAY CARE HOMEFACILITY NUMBER:
345002871
ADMINISTRATOR:CADWAY, TISAFACILITY TYPE:
735
ADDRESS:7855 GREENRIDGE WAYTELEPHONE:
(916) 961-8631
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY: 6CENSUS: 6DATE:
12/10/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Tisa Cadway, AdministratorTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Angela Hood arrived at the care home and met with the Administrator, Tisa Cadway, to conduct a pre-licensing inspection of the facility. LPA conducted COVID-19 assessment prior to arriving at the care home and wore a N-95 mask. Applicant holds current administrator certificate #6023707735 exp 2/22/23. . Licensee is changing locations of the facility and there are currently 6 residents residing at the old location.

LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are four bedrooms and three bathrooms for resident use. The bathrooms were in sanitary condition and the hot water temperature was observed to be 111 degrees F.

LPA checked the kitchen area for the ability to prepare and store food. LPA observed the area used for medication to be locked and inaccessible to residents.

LPA observed the perimeter of the care home to be free of clutter and debris and there appeared to be no potential safety hazards. The care home has hardwired smoke detectors and carbon monoxide detectors that are operational. Fire extinguisher is ready for emergency use.

Pre-licensing passed and Component III was previously completed. Applicant has satisfied all requirements in accordance to Title 22, California Code of Regulations. Application is pending and LPA will forward findings to the Centralized Application Bureau (CAB) for final review and approval. CAB will further contact applicant on final status of application. Exit interview conducted and copy of report provided to Administrator.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Angela Hood
LICENSING EVALUATOR SIGNATURE: DATE: 12/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2021
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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