<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347000775
Report Date: 02/23/2023
Date Signed: 02/23/2023 01:13:38 PM

Document Has Been Signed on 02/23/2023 01:13 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:DEBRA SHANDY RESIDENTIAL CARE HOMEFACILITY NUMBER:
347000775
ADMINISTRATOR:DEBRA SHANDYFACILITY TYPE:
735
ADDRESS:6165 LONGMONT WAYTELEPHONE:
(916) 966-6588
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 6CENSUS: 5DATE:
02/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Debra ShandyTIME COMPLETED:
02:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Cassie Yang arrived unannounced to the facility on 2/23/2023 to conduct an annual inspection. LPA met with Administrator, Debra Shandy, and explained the purpose of the visit. Prior to entering the facility, LPA ensure to apply hand sanitizer and wore a surgical mask.

The facility has a capacity of 6, today's census is 5.

LPA and Administrator toured the interior of the facility to ensure the health and safety of residents in care. In areas toured, no health, safety or personal rights violation were observed. LPA observed PPE supplied throughout the facility. LPA observed the facility to have trash can with lid and handwashing signs posted. LPA observed one client to be watching television in the common areas.

During inspection, LPA observed the facility to have ample supple of PPE's. LPA observed the facility to have 2+ days of perishable and 7+ days of non-perishable foods. LPA observed medication, toxins, and sharps to be locked and secured. LPA and Administrator discussed the possibility of facility closure in the future. Administrator reported no concerns at the facility at this time.

LPA observed Administrator Certificate #6001229735 to be up to date with expiration date of 5/22/2023.

Infection Control Domain was completed with Administrator, the facility is found to be in compliance. No deficiencies observed.

Exit interview conducted and a copy of the report was emailed to Administrator.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1