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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803794
Report Date: 05/02/2024
Date Signed: 05/02/2024 10:26:02 AM

Document Has Been Signed on 05/02/2024 10:26 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:CHICO'S HOMEFACILITY NUMBER:
486803794
ADMINISTRATOR/
DIRECTOR:		MORALES, CECILIAFACILITY TYPE:
735
ADDRESS:832 WORLEY RDTELEPHONE:
(707) 688-5075
CITY:SUISUN CITYSTATE: CAZIP CODE:
94585
CAPACITY: 4CENSUS: 3DATE:
05/02/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:47 AM
MET WITH:Nancy Bermudez, House Manager TIME VISIT/
INSPECTION COMPLETED:
10:40 AM
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On 5/2/2024, Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of following up on a fire clearance for staff living quarters. LPA was greeted by House Manager, and was informed that Licensee, Cecelia Morales was on vacation during the time of visit. LPA spoke with the License over phone and was informed that Suisun City Fire Marshal had conducted an inspection in March or April 2024. The Licensee stated that the Fire Marshal would be sending the clearance to Community Care Licensing but upon a review of records LPA has not yet received. In addition, the Licensee stated that along with the fire inspection, Suisun City Code Enforcement conducted an inspection and granted clearance. Due to Licensee's absence, LPA and House Manager were unable to locate the documentation.

During the visit, LPA contacted Suisun City Fire Department for a record request with no success. LPA observed staff living quarters to have appropriate smoke and carbon monoxide detectors with expiration dates labeled on them. LPA cannot confirm fire clearance or Fire Marshal inspection was conducted at this time. In addition, LPA contacted Suisun City Code Enforcement with no success.

LPA to follow up with both parties for documentation of fire clearance. At this time LPA did not observe any health and safety concerns for both staff and clients in care.

No deficiencies cited during the visit.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE: DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/02/2024
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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