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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005358
Report Date: 10/31/2022
Date Signed: 10/31/2022 03:59:55 PM

Document Has Been Signed on 10/31/2022 03:59 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:AMERICAN RIVER RESIDENTIAL SERVICESFACILITY NUMBER:
347005358
ADMINISTRATOR:SHAWNA VALVERDEFACILITY TYPE:
735
ADDRESS:4741 ENGLE ROADTELEPHONE:
(916) 483-8424
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 28CENSUS: 25DATE:
10/31/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:TIME COMPLETED:
04:00 PM
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On 10/31/2022, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced to conduct a Required 1 year annual inspection. LPA met with Program Director, Maritza Vindell, and explained the purpose of 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; LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask and face shield. Additionally, LPA was screened at the facility by staff.

LPA observed clients to be excited and prepared for the Trunk o Treating event in the parking lot. LPA and Program Director toured facility together to ensure health and safety of clients in care. Areas toured include but are not limited to dining room/bistro, tv room, spa room, and various client bedrooms. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Program Director completed the infection control domain together and facility was found to be in substantial compliance at this time.

During today's visit, LPA requested copies of the Administrator Certificate. No deficiencies are being cited as a result of todays inspection.

Exit interview conducted. A copy of this report will be emailed to Program Director.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 10/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2022
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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