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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803794
Report Date: 10/23/2023
Date Signed: 10/23/2023 12:13:28 PM

Document Has Been Signed on 10/23/2023 12:13 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:CHICO'S HOMEFACILITY NUMBER:
486803794
ADMINISTRATOR:MORALES, CECILIAFACILITY TYPE:
735
ADDRESS:832 WORLEY RDTELEPHONE:
(707) 688-5075
CITY:SUISUN CITYSTATE: CAZIP CODE:
94585
CAPACITY: 4CENSUS: 4DATE:
10/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Licensee, Celia MoralesTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Chico's Home for the purpose of conducting a Required 1 year inspection. LPA was greeted at the door by Licensee, Cecilia Morales, and was granted access into the facility. All clients are currently at their respective Day Programs. A prospective staff member was background cleared, but not associated to the facility. LPA educated the Licensee regarding submitting for finger print transfers to this facility (See LIC 9102-Technical Violation).

LPA and Licensee toured the facility. LPA observed the facility to be clean and at a comfortable temperature with all exits free from obstruction. However, during the tour, LPA observed an additional room in the garage that housed staff members. LPA did not observe this room on the facility sketch (See LIC 9102-Technical Advisory). Licensee disclosed that the City approved of this. LPA requested to submit a new facility sketch so that the room in the garage can be Fire Cleared for staff members. Fire Extinguisher was found to be last charged on December 2022 at the time of the inspection. All smoke detectors and carbon monoxide detectors were tested and found to be operational during the inspection. Water temperature in clients bathroom measured at 105 degrees, within acceptable range of 105 to 120 degrees F. Water temperature in the staff bathroom also measured at 116 degrees and is within acceptable range of 105 to 120 degrees. There was sufficient perishable and non-perishable foods located in the kitchen. Food menu was presently available for viewing during the inspection. Medications were centrally stored and locked. Medication Orders and Medications were reviewed during todays Required 1 year inspection. Cleaning products and other toxins are located in the laundry room that was locked and inaccessible to clients in care. There was a supply of Linens, cleaners, hygiene products and paper products available for clients. All bathrooms designated for clients in the common areas at the facility were supplied with individual paper towels and hand soap. Bathrooms in clients rooms have a towel and soap. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. A tour of all clients bedrooms were conducted, and bedrooms inspected have lighting and appropriate furnishing. (Report continued on LIC 809C)
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: CHICO'S HOME
FACILITY NUMBER: 486803794
VISIT DATE: 10/23/2023
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5 of 5 facility files were reviewed and found to be appropriate during the review. 4 of 4 client records were reviewed and found to be appropriate during the review.

Emergency Disaster Plan, Infection Control Plan, Staff and Client interviews will be conducted at a later date and time. No deficiencies were cited during today's Required 1 year inspection. Exit interview was conducted and a copy of this report was given to the Licensee, Cecilia Morales.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2023
LIC809 (FAS) - (06/04)
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