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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002659
Report Date: 12/21/2022
Date Signed: 12/21/2022 03:34:00 PM

Document Has Been Signed on 12/21/2022 03:34 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:CAZADERO HOME, INCFACILITY NUMBER:
455002659
ADMINISTRATOR:OSTERMAN, RUSSELLFACILITY TYPE:
735
ADDRESS:3556 CAZADERO WAYTELEPHONE:
(530) 262-5002
CITY:ANDERSONSTATE: CAZIP CODE:
96007
CAPACITY: 6CENSUS: 4DATE:
12/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Angel Doss and Tyler WebbTIME COMPLETED:
03:40 PM
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LPA Hiratsuka, conducted this unannounced annual visit. LPA wore a surgical mask and observed all staff wearing surgical masks. LPA was screened by Caregiver Crystal Cutcher.

This facility four resident rooms. The main entrance opens to the main common area that has the kitchen, dining, and sitting areas. To the left of the main entrance that has one resident room, a full bathroom and laundry room. To the right of the main entrance is one resident room and a hallway with two resident rooms, and full common bathroom. There is an door to the backyard next to the dining area.

Multiple topics were discussed.

No deficiencies cited.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE: DATE: 12/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/21/2022
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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