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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347000443
Report Date: 01/20/2023
Date Signed: 01/20/2023 05:13:57 PM


Document Has Been Signed on 01/20/2023 05:13 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:OAKS PRIVATE HOME CAREFACILITY NUMBER:
347000443
ADMINISTRATOR:TABB, LYDIAFACILITY TYPE:
740
ADDRESS:7016 LINCOLN OAKS DR.TELEPHONE:
(916) 961-5232
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY:6CENSUS: 6DATE:
01/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Stephanie Garcia, Acting AdministratorTIME COMPLETED:
05:30 PM
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Licensing Program Analyst (LPA) Michael Hood arrived at the facility unannounced on 1/20/2023 to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with Acting Administrator, Stephanie Garcia, 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. Additionally, LPA was screened by staff upon entry and signed visitor log with temperatures.

LPA toured the facility to ensure the health and safety of residents in care. Areas toured include but are not limited to: 6 bedrooms and 2 bathrooms for residents, 1 bedroom for staff, common area, kitchen, laundry room, outdoor area, and PPE supplies. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Acting Administrator 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: 01/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/20/2023
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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