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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455001755
Report Date: 03/29/2022
Date Signed: 03/29/2022 08:42:31 PM

Document Has Been Signed on 03/29/2022 08:42 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:BRAVO PROGRAM - ACCESS CENTERFACILITY NUMBER:
455001755
ADMINISTRATOR:ZIKAN, RODNEYFACILITY TYPE:
775
ADDRESS:9552 CROSSROADS DRIVETELEPHONE:
(530) 221-5251
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY: 15CENSUS: 11DATE:
03/29/2022
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Fern Mayfield, AdministratorTIME COMPLETED:
10:00 AM
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On 03/29/2022, Licensing Program Analysts (LPAs) Misty Valencia and Shannon Diegoruelas conducted an announced complaint investigation visit regarding the above allegation directed by the department. LPAs met with Fern Mayfield, Administrator and explained the reason for the visit. Prior to initiating 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 Administrator 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: surgical mask. Additionally, LPA was screened by staff at the front door.

This is a collateral visit to interview clients at day program.

Complaint allegation needs further investigation.

No deficiencies during todays visit. Exit interview conducted and a copy of report was emailed to Administrator
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Misty Valencia
LICENSING EVALUATOR SIGNATURE: DATE: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/29/2022
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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