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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525002806
Report Date: 07/12/2021
Date Signed: 07/12/2021 02:48:25 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:GILMORE PLACEFACILITY NUMBER:
525002806
ADMINISTRATOR:WILCOX, JULIEFACILITY TYPE:
740
ADDRESS:70 GILMORE ROADTELEPHONE:
(530) 727-9293
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY:22CENSUS: DATE:
07/12/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Julie Wilcox, administratorTIME COMPLETED:
03:00 PM
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7/12/2021 1:00 PM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility unannounced to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with Administrator Julie Wilcox and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; contacted administrator and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical mask, gloves. Additionally, LPA Knight was screened by facility staff.

LPA Knight and Ms.Wilcox toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: resident bedrooms, common areas, bathrooms, kitchen and storage rooms. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA Knight and the administrator completed the infection control domain and facility was found to be in substantial compliance at this time.

No deficiencies are being cited as a result of todays inspection. Technical assistance was provided.

Exit interview conducted and copy of report was given to Administrator Julie Wilcox.
SUPERVISOR'S NAME: Rayna L BrysonTELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Rebecca KnightTELEPHONE: (530) 895-4356
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2021
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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