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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515001557
Report Date: 12/28/2022
Date Signed: 12/28/2022 04:11:46 PM

Document Has Been Signed on 12/28/2022 04:11 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:HARVEY CARE HOMEFACILITY NUMBER:
515001557
ADMINISTRATOR:HARVEY, JANAFACILITY TYPE:
735
ADDRESS:1144 JOSEPHTELEPHONE:
(530) 674-3526
CITY:YUBA CITYSTATE: CAZIP CODE:
95993
CAPACITY: 6CENSUS: 6DATE:
12/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Jana HarveyTIME COMPLETED:
04:20 PM
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LPA Hiratsuka conducted this unannounced annual visit. LPA wore a surgical mask and observed all staff wearing masks.

The main entrance opens to the main common area that includes sitting, dining, and kitchen. To the left of the main common area is a hallway leading to the three shared resident rooms and one full common bathroom and the largest room has a full bathroom. To the right of the main entrance is a sitting area. Next to the dining room is the laundry room that leads to a staff area that has two staff rooms and a staff bathroom from the staff area. There is a door leading to the backyard from the dining room. There is a detached garage.

Multiple topics were discussed.

No deficiencies cited.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE: DATE: 12/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/28/2022
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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