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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347002829
Report Date: 12/30/2022
Date Signed: 12/30/2022 12:42:12 PM


Document Has Been Signed on 12/30/2022 12:42 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:VILLA LINDAFACILITY NUMBER:
347002829
ADMINISTRATOR:BACHIS, GAVRILFACILITY TYPE:
740
ADDRESS:6501 LINDA WAYTELEPHONE:
(916) 217-2056
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: 6DATE:
12/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Gabril BachisTIME COMPLETED:
01:00 PM
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On 12/30/2022, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a Required 1-year inspection. LPA met with Licensee, 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.

The facility currently has six (6) residents with one (1) resident on hospice services. LPA observed the license to not be update for hospice waiver but observed Licensee to have an approved hospice waiver letter. LPA informed Licensee the license will be updated and sent to the facility. LPA and Licensee discussed the possibility of increasing hospice waiver, LPA informed Licensee she will provide Licensee the criteria required in the hospice increase waiver request.

LPA and Licensee toured the interior of the facility to ensure the health and safety of residents in care. In areas toured, no immediate health and safety violations were observed. LPA observed sharps, toxics, and medication to be locked and secured. LPA observed the fire extinguisher to be last serviced on 8/11/2022. LPA observed the Administrator Certificate #6011253740 to be expired but was informed by Licensee the renewal was submitted in December 2021. LPA observed Licensee to be have certificates of CEU hours of 81. LPA informed Licensee she will follow up with Administrator Cert unit and provided Licensee the email to Admin Cert unit.

Licensee discussed concerns with LPA that all his documents states "Gavril" when the corrective spelling is "Gabriel". LPA informed Licensee she will correct the spelling in the system. LPA obtained a copy of the liability insurance via email by Licensee.

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.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: 916-201-1928
LICENSING EVALUATOR SIGNATURE:
DATE: 12/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/30/2022
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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