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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001879
Report Date: 01/04/2023
Date Signed: 01/04/2023 10:18:50 AM

Document Has Been Signed on 01/04/2023 10:18 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
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:ED DAVID CARE HOME #1FACILITY NUMBER:
347001879
ADMINISTRATOR:MARINA DAVIDFACILITY TYPE:
735
ADDRESS:7125 CANAVERAL WAYTELEPHONE:
(916) 332-2218
CITY:NORTH HIGHLANDSSTATE: CAZIP CODE:
95660
CAPACITY: 6CENSUS: 6DATE:
01/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:39 AM
MET WITH:Marta Blanco, AdministratorTIME COMPLETED:
10:40 AM
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On January 4, 2023, at 9:40am, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived unannounced to conduct an 1 year required annual review. LPA met with Marta Blanco Administrator and informed her the reason for the visit.
Prior to visit, LPA completed the required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19, contacted licensee and completed a facility risk assessment. LPA ensured she applied hand sanitizer before entering the facility and worn a mask for Personal Protective Equipment (PPE). Additionally, LPA was screened by the front desk personnel upon arrival.

Marta and LPA completed the inspection tool questionnaire with no issues or advisories to report.

LPA observed the following:

LPA toured the facility to ensure the health and safety of residents in care. Areas toured include but are not limited to: 3 bedrooms and 2 bathrooms for residents, common area, dining room, food supply, PPE supply, garage, and outdoor area. In the areas toured no immediate health, safety, or personal rights violations were observed. Administrator certificate is valid, expiring 6/23/2023. First aid kit fully stocked and ready for emergency use. Fire extinguishers is charged. Common areas were clean and in good repair. Bedrooms had required furniture and lighting. Facility has required (2) day perishable supply of food and (7) supply of non-perishable food. Medication was properly stored and locked away.

As a result of this visit, no deficiencies were cited, per Title 22 Regulations..

Exit interview conducted and a copy of this report given to Marta.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons
LICENSING EVALUATOR SIGNATURE: DATE: 01/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/04/2023
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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