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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515002956
Report Date: 01/17/2023
Date Signed: 01/17/2023 11:27:50 AM

Document Has Been Signed on 01/17/2023 11:27 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:ABUNDO'S RESIDENTIAL CAREFACILITY NUMBER:
515002956
ADMINISTRATOR:ABUNDO, EMMANUELFACILITY TYPE:
735
ADDRESS:10191 HYACINTH WAYTELEPHONE:
(408) 348-3453
CITY:LIVE OAKSTATE: CAZIP CODE:
95953
CAPACITY: 4CENSUS: 0DATE:
01/17/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Emmanual AbundoTIME COMPLETED:
11:40 AM
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LPA Hiratsuka, conducted this announced prelicensing visit. LPA wore a surgical mask and observed Applicant wearing one.

The facility has a fire clearance for three ambulatory and one non-ambulatory for a total four residents. This facility has four private bedrooms and one staff room. The main entrance opens to a small foyer. To the left of the main entrance is a nook that has a closet, desk, and door leading to the garage. The garage has a staff room. The staff room has a door leading to the private bathroom of the largest private room. The door has a lock on it preventing its use so staff cannot use the bathroom and the resident room as a pass-through. To the right of the main entrance is a hallway leading to three private resident rooms, laundry room, and full common bathroom. To the left of the main entrance and past the nook is a hallway that leads to the forth private resident room with its own full private bathroom. The main common, dining, and kitchen area is in the back. There is a sliding glass door in the back leading to the backyard. The backyard has a locked shed on the left side. There is a gate on the same side as the garage. There are several locked cabinets in the facility that is going to be used for confidential storage and items that should be not accessible to residents.

Component III orientation was conducted.

Several topics were discussed.

This facility meets regulations. LPA is going to submit this report to the application specialist.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2023
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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