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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
515000960
Report Date:
10/11/2022
Date Signed:
10/11/2022 12:35:46 PM
Document Has Been Signed on
10/11/2022 12:35 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
CHICO - RESIDENTIAL
,
520 COHASSET RD., STE. 170
CHICO
,
CA
95926
FACILITY NAME:
COMMUNITY RESOURCE SERVICES #5
FACILITY NUMBER:
515000960
ADMINISTRATOR:
KOLL, GAIL
FACILITY TYPE:
775
ADDRESS:
732 PLUMAS STREET
TELEPHONE:
(530) 751-2026
CITY:
YUBA CITY
STATE:
CA
ZIP CODE:
95991
CAPACITY:
49
CENSUS:
23
DATE:
10/11/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
11:25 AM
MET WITH:
Teresa Villa
TIME COMPLETED:
12:45 PM
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LPA Hiratsuka conducted this unannounced annual visit. LPA wore a surgical mask during this visit. Program Coordinator
Teresa Villa
arrived during visit. LPA toured the facility with staff member Donna Winnen.
This program is in a building that has an entrance on the side that leads to a parking lot and has a ramp on the inside. The front entrance opens into an area that sells the art the clients make. There is a partition that separates the store from the work space for the clients. There is a snack area towards the back just before the doorway in the back on the right. In the back there are a couple of storage areas and a restroom for the clients and staff of the program only.
A couple of topics were discussed. LPA observed staff wearing masks during visit. LPA also inspected the personal protective equipment supply.
No deficiencies cited.
SUPERVISORS NAME
:
Troy Ordonez
LICENSING EVALUATOR NAME
:
Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE
:
DATE:
10/11/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/11/2022
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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