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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002003
Report Date: 07/13/2022
Date Signed: 07/13/2022 10:34:52 AM

Document Has Been Signed on 07/13/2022 10:34 AM - 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:BROAD HORIZONFACILITY NUMBER:
455002003
ADMINISTRATOR:KINGSLEY, SHERRIEFACILITY TYPE:
775
ADDRESS:465 LAKE BLVDTELEPHONE:
(530) 243-9500
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY: 0CENSUS: 20DATE:
07/13/2022
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
10:09 AM
MET WITH:Sherrie Kingsley, Administrator.TIME COMPLETED:
11:00 AM
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On 07/13/2022 at 10:15am, Licensing Program Analyst (LPA) Misty Valencia arrived unannounced to conduct a Collateral case management visit. LPA met with Sherrie Kingsley, Administrator.

During the inspection the LPA interviewed one (1) client and collected documents.

As a result of this inspection, no deficiencies

No deficiencies are being cited as a result of todays inspection.

Exit interview conducted and copy of report emailed to Administrator.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Misty Valencia
LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2022
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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