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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002926
Report Date: 12/22/2022
Date Signed: 12/22/2022 12:22:36 PM

Document Has Been Signed on 12/22/2022 12:22 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:CHARADE HOMEFACILITY NUMBER:
455002926
ADMINISTRATOR:MONTGOMERY, YVETTE L.FACILITY TYPE:
735
ADDRESS:1943 CHARADE WAYTELEPHONE:
(530) 515-8314
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY: 4CENSUS: 0DATE:
12/22/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Yvette MontgomeryTIME COMPLETED:
12:30 PM
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LPA Hiratsuka conducted this announced prelicensing visit. LPA wore a surgical mask and observed Licensee was wearing a surgical mask. Crystal Monismith, Administrator participated during the visit via phone.

This facility has a fire clearance from ambulatory only. The main entrance opens to the main sitting area on the right. To the left has a private resident room that has second door that leads to the hallway. To the left of the main entrance past the bedroom is the hallway leading to the four private resident rooms, laundry room that has a door leading to the garage, one full common bathroom, and one full bathroom that is going to be used for storage, visitors, and staff only. That bathroom door is going to have a keypad lock on it. Beyond the sitting room towards the back of the facility is the kitchen and dining area. The backyard was inspected. The gate is on the same side as the garage.

Component III orientation was conducted.

This facility meets regulations. LPA is going to submit this to the application specialist.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE: DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/22/2022
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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