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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002983
Report Date: 11/17/2022
Date Signed: 11/17/2022 04:40:31 PM

Document Has Been Signed on 11/17/2022 04:40 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:LOMOND HOMEFACILITY NUMBER:
345002983
ADMINISTRATOR:SORONGON, ESPERANZAFACILITY TYPE:
734
ADDRESS:4841 LOCH LOMOND DRTELEPHONE:
(650) 580-3896
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 5CENSUS: 5DATE:
11/17/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Shiryl MishraTIME COMPLETED:
05:00 PM
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On 11/17/2022, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a case management visit. LPA met with Facility Assistant Administrator and explained the purpose of the visit. LPA arrived at the facility wearing a surgical mask and additionally, LPA was screened upon entrance by Licensee.

LPA and Assistant Administrator toured the interior of the facility to ensure the health and safety of clients in care. LPA observed the facility to have (1) registered nurse, (2) direct support professional, (1) Facility Assistant Administrator and Licensee to be present at the facility. In the areas toured, no immediate health, safety and personal rights violation were observed.

Assistant Administrator informed LPA staff has not been paid by previous Licensee for the pay period of October 31, 2022 to 3PM of November 1, 2022. Assistant Administrator stated their vacation hours was also not paid out by previous Licensee as well as COVID-19 sick hours. Assistant Administrator reported one staff personnel file to be missing, allegedly taken by previous Licensee. LPA was informed there are no other concerns at this moment.

As a result of today's inspection, no deficiencies were observed.

Exit interview conducted and a copy of the report was left at the facility.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2022
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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