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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515000683
Report Date: 11/02/2022
Date Signed: 11/02/2022 10:40:02 AM


Document Has Been Signed on 11/02/2022 10:40 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:COURTYARD, THEFACILITY NUMBER:
515000683
ADMINISTRATOR:PICKARD, CAROLFACILITY TYPE:
740
ADDRESS:1240 WILLIAMS WAYTELEPHONE:
(530) 790-3050
CITY:YUBA CITYSTATE: CAZIP CODE:
95991
CAPACITY:80CENSUS: 54DATE:
11/02/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Carol PickardTIME COMPLETED:
10:45 AM
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LPA Hiratsuka, conducted this unannounced case management visit.

This visit is in response to an incident reported to LPA while LPA was conducting an annual at the sister facility. When LPA arrived at the other facility, LPA was told by the administrator and nurse manager of both buildings that this facility was evacuated this morning about 6:30am due to smoke in the building. The residents were outside for roughly fifteen minutes. Fire department cleared the building for occupation and all residents are back inside. Everything is clean. The licensee's engineering department staff showed up to check and cleared the building. The staff conducted their emergency evacuation procedures. No residents or staff were injured during the evacuation.

No deficiencies cited.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Kerry HiratsukaTELEPHONE: (916) 591-0210
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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