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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003247
Report Date: 02/28/2023
Date Signed: 02/28/2023 03:19:13 PM


Document Has Been Signed on 02/28/2023 03:19 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:EMILY'S GUEST HOMEFACILITY NUMBER:
347003247
ADMINISTRATOR:TINTAS, MARIAFACILITY TYPE:
740
ADDRESS:7437 KANAI AVENUETELEPHONE:
(916) 745-3711
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:6CENSUS: 1DATE:
02/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Maria Tintas- AdministratorTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced on 02/28/2023 to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with Administrator, Maria Tintas, 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.

LPA toured the facility to ensure the health and safety of the resident in care. Areas toured include but are not limited to: four (4) bedrooms and one (1) bathroom for residents, common area, dining room, and food supply. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Administrator completed the infection control domain and facility was found to be in substantial compliance at this time.

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: Sarena KeosavangTELEPHONE: (209) 202-9552
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2023
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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