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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001766
Report Date: 10/06/2022
Date Signed: 10/06/2022 12:15:45 PM

Document Has Been Signed on 10/06/2022 12:15 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:JOWELLA CHICO'S CARE HOMEFACILITY NUMBER:
347001766
ADMINISTRATOR:CAPISTRANO, ELIZABETH C.FACILITY TYPE:
735
ADDRESS:8442 SUNRISE BOULEVARDTELEPHONE:
(916) 726-7283
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 6CENSUS: 5DATE:
10/06/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Jowell Chico, Licensee TIME COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Maria Lina, caregiver, and explained purpose of inspection. LPA then met with Ana Lou Zabala, caregiver. Jowell Chico, Licensee, who arrived at 10:15 am. Administrator Christina Chico, was unable to attend today's inspection. Prior to initiating today's inspection, LPA completed required COVID-19 protocols. LPA was screened per Covid-19 precautionary measures upon entering the facility. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. The facility is a licensed 4I - Prader Willi home that is vendorized through Alta California Regional Center for (6) ambulatory clients only. LPA observed (5) of (5) clients in the common area.
LPA and Licensee toured the interior and exterior of the facility including the common areas, (4) client bedrooms, (2) bathrooms, kitchen, staff room and bathroom, and laundry area. LPA observed the home to be clean, safe and in good repair and to not pose a health and safety risk or personal rights violation. LPA observed various Covid posters and other required postings to be posted in the office area. Administrator to post Ombudsman poster, Resident Personal Rights, and CCLD See Something Say Something poster
in a conspicuous area. Inside temperature was observed to be 74* F. Facility conducts monthly fire drills- documentation observed. The facility has a large back yard area with seating and a front parking gate.. LPA observed locked toxins, medications and sharps and sufficient 2+day perishable/7+day non-perishable food. The kitchen door is locked when staff is not inside due to clients having Prader-Willi Syndrome. LPA observed paper towels, soap, and 20-second hand-washing posters in the bathrooms- Licensee agreed to place trash cans with lids in the bathrooms. PPE supply on hand is sufficient. LPA provided (4) individual sanitizers from Department. Discussed resident and staff vaccination status and eligibility for booster shot and provided booster flyer. Discussed visitation protocols- update visitor sign and log. LPA requested documentation to update Administrator name to Christina Chico as well as LIC308, LIC500.
There were no deficiencies observed
.Exit interview. Copy of report left at facility.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2022
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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