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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
515001963
Report Date:
01/19/2023
Date Signed:
01/19/2023 01:35:43 PM
Document Has Been Signed on
01/19/2023 01:35 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:
WILLOW GLEN CARE CENTER
FACILITY NUMBER:
515001963
ADMINISTRATOR:
ANGIE KARIS
FACILITY TYPE:
740
ADDRESS:
1547 PLUMAS COURT
TELEPHONE:
(530) 751-9900
CITY:
YUBA CITY
STATE:
CA
ZIP CODE:
95991
CAPACITY:
60
CENSUS:
57
DATE:
01/19/2023
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
12:00 PM
MET WITH:
Angie Karis
TIME COMPLETED:
01:45 PM
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LPA Hiratsuka conducted this unannounced annual visit. LPA wore a surgical mask and observed all staff wearing surgical masks. LPA was screened by the front desk.
The main entrance of this building opens to a reception area that is shared by another facility licensed by Community Care Licensing Division. The entrance to the facility itself is to the right of the main reception area. This facility has a layout of the main common area that has the dining and there are two wings.
During this visit LPA toured the facility with Administrator Angie Karis.
Multiple topics were discussed.
No deficiencies cited.
SUPERVISOR'S NAME:
Lauren Crocker
TELEPHONE:
(530) 895-5033
LICENSING EVALUATOR NAME:
Kerry Hiratsuka
TELEPHONE:
(916) 591-0210
LICENSING EVALUATOR SIGNATURE:
DATE:
01/19/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/19/2023
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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