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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002689
Report Date: 01/25/2023
Date Signed: 01/25/2023 04:28:55 PM

Document Has Been Signed on 01/25/2023 04:28 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:CAPELLA HOME #2 INCFACILITY NUMBER:
455002689
ADMINISTRATOR:OSTERMAN, RYANFACILITY TYPE:
735
ADDRESS:2561 CAPELLA STTELEPHONE:
(530) 262-5002
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY: 6CENSUS: 3DATE:
01/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Angel DossTIME COMPLETED:
04:35 PM
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LPA Hiratsuka conducted this unannounced annual visit. LPA wore a surgical mask and observed all staff wearing masks. LPA was screened by Caregiver Laneah Rouse. Administrator Angel Doss arrived shortly after and finished the visit.

This facility has a fire clearance for four non-ambulatory and two ambulatory for a total of six residents. The entrance opens to a short hallway. To the right is a hallway that leads to the four resident rooms and one full common bathroom. Three bedrooms have exits to the outside and one bedroom has a full private bathroom. To the left of the main entrance leads to the dining, kitchen, and common area. There is a door to the garage next to the kitchen.

A couple topics discussed.

No deficiencies cited.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE: DATE: 01/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/25/2023
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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