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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002555
Report Date: 10/20/2021
Date Signed: 10/20/2021 01:24:19 PM

Document Has Been Signed on 10/20/2021 01:24 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:OSTERMAN CERRO, INC.FACILITY NUMBER:
455002555
ADMINISTRATOR:OSTERMAN, RYANFACILITY TYPE:
735
ADDRESS:4582 CERRO LANETELEPHONE:
(530) 949-8756
CITY:REDDINGSTATE: CAZIP CODE:
96001
CAPACITY: 6CENSUS: 5DATE:
10/20/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Administrator Angel DossTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Valencia arrived at the facility unannounced on 10/20/2021 to conduct a case management visit, LPA met with administrator Angel Doss and explained the purpose of the visit. Prior to initiating the case management, 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 they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 Mask. Additionally, LPA was screened by facility staff upon entry.

LPA received a phone call regrading an incident that happened between a staff member and client from facility from Administrator (Admin) Angel Doss. LPA interviewed Angel Doss and collected requested documents.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Misty Valencia
LICENSING EVALUATOR SIGNATURE: DATE: 10/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2021
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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