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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005332
Report Date: 10/05/2022
Date Signed: 10/05/2022 03:55:31 PM


Document Has Been Signed on 10/05/2022 03:55 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:CHRISMAN COMMUNITYFACILITY NUMBER:
347005332
ADMINISTRATOR:CLAUDIA MIHAIFACILITY TYPE:
740
ADDRESS:4230 PARADISE DRIVETELEPHONE:
(916) 515-8590
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: DATE:
10/05/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Administartor, Claudia MihaiTIME COMPLETED:
04:00 PM
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On 10/5/2022, Licensing Program Analyst (LPA) Cassie Yang arrived to the facility unannounced to conduct a Required 1-Year annual inspection. LPA met with caregiver, Mauvette Henriques, and stated the reason for the inspection. Caregiver contacted Administrator, Claudia Mihai, by phone who arrived shortly to the facility. LPA observed caregiver to not have a mask on, LPA informed caregiver that face covering/mask is still mandated in the facility while residents are in care. Caregiver confirmed there are (5) residents present and currently (2) residents receive hospice services.

LPA and Administrator toured the interior and exterior of the facility. In areas toured included but not limited to: (5) bedrooms, (2) bathroom, kitchen, laundry room, garage, backyard, and common areas. LPA observed it to be clean, in good repair and to be odor free and the toxins, sharps and medications to be locked. LPA observed the facility to have 2+ day of perishable and 7+ days of non-perishables food. LPA informed Administrator to have handwashing sign posted in the bathroom. LPA observed the facility to have ample PPE supplies. LPA observed soap to be in the bathroom. LPA observed the facility to have the mandatory Ombudsman and CCLD IF YOU SEE SOMETHING sign to be posted. LPA observed Administrator Certificate #6052833740 to be updated with expiration date of 7/31/2023.

LPA requested and obtained copies of the LIC 308, LIC 500 and a copy of the current liability insurance.

As a result of today's inspection, deficiency was observed. Please see attached LIC 809-D.

Copy of report and appeal rights was provided to Administrator.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 10/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/05/2022
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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Document Has Been Signed on 10/05/2022 03:55 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926


FACILITY NAME: CHRISMAN COMMUNITY
FACILITY NUMBER: 347005332

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/05/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87468.1(a)(2)


This requirement is not met as evidenced by:
Deficient Practice Statement
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87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(2) To be accorded safe, healthful... This requirement is not met as evidenced by: Based on observation of Caregiver was not wearing mask, the licensee did not comply with the section cited above that all staff are to wear maks regardless of vaccination status which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/19/2022
Plan of Correction
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LPA asked Caregiver to put on a mask imeediately.
Licensee is to submit a statement of understanding and compliance, that all staff and visitors are to wear mask while residents are in care, to CCLD by 10/19/2022.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Cassie YangTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 10/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/05/2022
LIC809 (FAS) - (06/04)
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