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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002943
Report Date: 01/25/2023
Date Signed: 01/25/2023 10:24:32 AM

Document Has Been Signed on 01/25/2023 10:24 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:ICAREHOMES INC.FACILITY NUMBER:
455002943
ADMINISTRATOR:HOOKHAM, MARIELFACILITY TYPE:
735
ADDRESS:3457 CAPRICORN WAYTELEPHONE:
(530) 917-6995
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY: 6CENSUS: 0DATE:
01/25/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Mariel HookhamTIME COMPLETED:
10:35 AM
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LPA Hiratsuka conducted this announced prelicensing visit. LPA wore a surgical mask and so did Applicant.

This facility has a fire clearance for two non-ambulatory and four ambulatory for a total of six residents. This facility has four resident rooms; two are non-ambulatory rooms. The main entrance opens to a very small foyer. To the right of the main entrance is a hallway leading to the four resident rooms and a full common bathroom. Two of the resident rooms have exits to the outside. One of the rooms that has an exit also has a full private bathroom. To the left of the main entrance leads to the dining, kitchen, and sitting area. There is an exit to the outside from the sitting area. There is a door leading to the garage from the kitchen. There is a locked closet for medications and files in the kitchen area. There is a gate on both sides of the facility. The clothes washer and dryer are in the garage.

Component III orientation was conducted.

This facility meets regulations. LPA is going to submit this report to the application specialist.
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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