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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 517003436
Report Date: 11/02/2022
Date Signed: 11/02/2022 09:40:24 AM

Document Has Been Signed on 11/02/2022 09:40 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:GARDENS ADULT DAY PROGRAM, THEFACILITY NUMBER:
517003436
ADMINISTRATOR:PICKARD, CAROLFACILITY TYPE:
775
ADDRESS:840 WASHINGTON AVENUETELEPHONE:
(530) 790-3075
CITY:YUBA CITYSTATE: CAZIP CODE:
95991
CAPACITY: 15CENSUS: 1DATE:
11/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jamie ScottTIME COMPLETED:
09:45 AM
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LPA Hiratsuka, conducted this annual visit. LPA toured with Jamie Scott, Nurse Manager. LPA wore surgical mask and observed all staff wearing surgical masks.

This program is in the same building as The Gardens 515001365. This program utilizes one quiet room and the activity room. The day program shares staff with the facility of The Gardens. The residents and clients are not left alone with each other. The program operates Monday through Friday 8:00am to 5:00pm. This program shuts down if there is any emergency within the facility.

LPA reviewed two resident and two staff files.

This facility meets regulations.

No deficiencies cited.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
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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