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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003327
Report Date: 11/17/2022
Date Signed: 11/17/2022 02:11:54 PM

Document Has Been Signed on 11/17/2022 02:11 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:AILEEN CANTOR-FERMO RESIDENTIAL CARE HOMEFACILITY NUMBER:
347003327
ADMINISTRATOR:FERMO-CANTOR, AILEENFACILITY TYPE:
735
ADDRESS:7016 22ND STREETTELEPHONE:
(916) 992-1904
CITY:RIO LINDASTATE: CAZIP CODE:
95673
CAPACITY: 6CENSUS: 6DATE:
11/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Aileen Cantor LIcensee, TIME COMPLETED:
11:00 AM
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On November 17, 2022, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived unannounced to conduct an 1 year required annual Inspection. LPA met with Aileen Cantor, Licensee, and explained the reason for the visit.

Prior to the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; contacted licensee and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Masks.

Aileen and LPA completed the Covid infectious control questionnaire with no advisories.
LPA and Aileen toured the home. All rooms have the required furniture. The bathrooms clean. LPA observed an adequate amount of linens and found the first aid kit to be complete. Hot water temperature measures at 105 degrees F. There are no bodies of water on the premises. The administrator's certificate was valid expiring in 2023.

Per California Code of Regulation, Title 22, No violations was observed. No citations were issued.
The administrator shall submit updated copies of the LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610D the Emergency Disaster Plan, and copy of current Liability Insurance to update the facility file. Administrator shall submit the listed documents to Licensing no later than December 17, 2022.

An exit interview was conducted and a copy of this report was given to Aileen

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons
LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2022
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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