<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002710
Report Date: 10/04/2022
Date Signed: 10/04/2022 11:29:17 AM

Document Has Been Signed on 10/04/2022 11:29 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
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:OAK HAVEN HOMEFACILITY NUMBER:
455002710
ADMINISTRATOR:WARREN, VANESSAFACILITY TYPE:
735
ADDRESS:3440 OAK HAVEN COURTTELEPHONE:
(530) 319-3888
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY: 4CENSUS: 3DATE:
10/04/2022
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Vanessa Warren - administratorTIME COMPLETED:
11:30 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
10/04/2022 11:00 AM Licensing Program Analyst (LPA) Rebecca Knight, made an unannounced visit to the facility and met with administrator Vanessa Warren. The purpose of this visit was to interview the administrator regarding an incident report that was submitted regarding a client that attends Bravo Access day program.

Prior to initiating the visit, LPA completed 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: N95 mask, gloves.

LPA interviewed the administrator and requested copies of the following documents: Staff list with phone numbers, Physicians documentation of visit for C1.

No deficiencies cited. Exit interview conducted and a copy of the report was emailed to administrator Vanessa Warren.

SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1