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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002559
Report Date: 10/20/2021
Date Signed: 10/20/2021 10:01:55 AM

Document Has Been Signed on 10/20/2021 10:01 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:OAK MESA HOMEFACILITY NUMBER:
455002559
ADMINISTRATOR:BAUGHMAN, LINDSAYFACILITY TYPE:
735
ADDRESS:1870 OAK MESATELEPHONE:
(530) 215-3973
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY: 6CENSUS: 5DATE:
10/20/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Lindsay BaughmanTIME COMPLETED:
10:00 AM
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On 10/20/2021 Licensing Program Analysts (LPA) Misty Valencia arrived at the facility unannounced to conduct a Required-1 Year Inspection utilizing the infection control domain, LPA met with Lindsay Baughman, Administrator and explained the purpose of the visit. Prior to initiating the annual inspection, LPAs 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 licensee 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: N95 Mask. Additional LPA was screen at the back door before entering the facility.

LPA Valencia and Ms Baughman toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to common areas, six (6) resident bedrooms, three (3) bathrooms, kitchen, storage areas, and back yard. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA Valencia and Ms. Baughman completed the infection control domain and facility was found to be in substantial compliance at this time.

No deficiencies are being cited as a result of todays inspection. Copy of the report emailed to Ms. Baughman
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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