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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005332
Report Date: 02/14/2023
Date Signed: 02/14/2023 05:39:21 PM


Document Has Been Signed on 02/14/2023 05:39 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
CCLD Regional Office, 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: 5DATE:
02/14/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Claudia MihaiTIME COMPLETED:
05:45 PM
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On 2/14/23, LPA Mknelly visited for a pre-licensing inspection for a pending application.
LPA followed the department Covid 19 protocols, wore a surgical mask.

The home was clean and in good repair.
Residents are receiving care as identified.

No deficiencies are cited as a result of this inspection.

Report reviewed and copy provided.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2023
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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