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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002764
Report Date: 08/31/2022
Date Signed: 08/31/2022 02:55:49 PM


Document Has Been Signed on 08/31/2022 02:55 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:SAINT LORENZ ASSISTED LIVINGFACILITY NUMBER:
455002764
ADMINISTRATOR:BIRD, JAMESFACILITY TYPE:
740
ADDRESS:740 LAKE BLVDTELEPHONE:
(650) 632-5300
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY:17CENSUS: 15DATE:
08/31/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Debbie Bird, Assistant AdministratorTIME COMPLETED:
03:00 PM
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08/31/2022 Licensing Program Analyst (LPA) Shannon Diegoruelas, arrived at the facility unannounced to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with Debbie Bird, Assistant Administrator and explained the purpose of the visit. Prior to initiating the annual inspection, 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 contacted facility 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: Surgical mask. Additionally, LPA was screened by Administrator assistant.

LPA and Debbie toured facility to ensure health and safety of residents in care. Areas toured include but are not limited to: outdoor area, one common area, two (2) bathrooms, three (3) resident rooms, kitchen, dinning room, storage areas. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Debbie 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 today’s inspection.

Exit interview conducted and copy of report was provided to Debbie.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Shannon DiegoruelasTELEPHONE: (530) 282-2393
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2022
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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