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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002959
Report Date: 11/02/2022
Date Signed: 11/02/2022 11:46:15 AM


Document Has Been Signed on 11/02/2022 11:46 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:SUNDIAL ASSISTED LIVINGFACILITY NUMBER:
455002959
ADMINISTRATOR:OGDEN, TREVORFACILITY TYPE:
740
ADDRESS:395 HILLTOP DRIVETELEPHONE:
(530) 241-2900
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY:65CENSUS: 24DATE:
11/02/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Amber Buxton Administrator and Christopher Labra, LVNTIME COMPLETED:
12:00 PM
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11/02/2022 Licensing Program Analyst (LPA) Shannon Diegoruelas, arrived at the facility unannounced to conduct a pre-licensing inspection. LPA met with Christopher Labra, LVN and Amber Buxton, Administrator and explained the purpose of the visit. Prior to initiating the pre-licensing inspection, LPA completed required COVID-19 daily self-screening 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 facility staff.

LPA, LVN, and Administrator completed the pre-licensing inspection tool domain, and the facility was found to be in substantial compliance. LPA and LVN conducted a walk-through of the facility and ensured all physical plant requirements.



Component III was conducted and completed with Administrator and LVN. LPA will notify CAB that the facility is ready for licensing.

Exit interview conducted and copy of report was provided to Administrator

SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Shannon DiegoruelasTELEPHONE: (530) 282-2393
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2022
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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