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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525002208
Report Date: 08/13/2024
Date Signed: 08/13/2024 02:32:26 PM

Document Has Been Signed on 08/13/2024 02:32 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:NORTH VALLEY SERVICES - A/C WESTFACILITY NUMBER:
525002208
ADMINISTRATOR/
DIRECTOR:		COX, CONNIEFACILITY TYPE:
775
ADDRESS:12097 HWY 99 WTELEPHONE:
(530) 527-9602
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY: 60CENSUS: 20DATE:
08/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Connie Cox - administratorTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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08/13/2024 12:15 PM Licensing Program Analysts (LPAs) Rebecca Knight and Farhaan Saranghi arrived at the facility unannounced to conduct a Required-1 Year inspection. LPAs met with administrator Connie Cox and explained the purpose of the visit.
LPA's and the administrator toured the facility together to ensure the health and safety of clients who attend program. Areas toured include but are not limited to common areas, bathrooms, kitchen, storage areas and back yard. Staff and resident files were reviewed. All employees requiring background checks are cleared.

There is a schedule of recreational activities planned for the clients and clients are given the choice to go out in the community or stay at program each day.

The facility was observed to be at a comfortable temperature. Common area was clean and in good repair. Bathrooms were clean and in good repair. Kitchen was clean and in good repair. Fire extinguishers fully charged and were inspected in August 2023. Smoke detectors are all operational. No pools/bodies of water are on premises. Last disaster drill was conducted in August 2024 which was an active shooter drill, the facility has been conducting fire drills monthly.
LPA requested the following documents be sent to the Chico district office:
Emergency Disaster Plan
Updated property lease

In the areas toured no immediate health, safety, or personal rights violations were observed. No deficiencies are being cited as a result of today’s inspection.

Exit interview conducted and copy of report was provided to administrator Connie Cox.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE: DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2024
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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