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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525002968
Report Date: 01/12/2023
Date Signed: 01/12/2023 01:56:49 PM

Document Has Been Signed on 01/12/2023 01:56 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:LIBERTYFACILITY NUMBER:
525002968
ADMINISTRATOR:PHELPS, ASHLEYFACILITY TYPE:
735
ADDRESS:22891 OAK VIEW DRIVETELEPHONE:
(530) 200-2909
CITY:RED BLUFFSTATE: CAZIP CODE:
96080
CAPACITY: 4CENSUS: 0DATE:
01/12/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Ashly Phelps - licenseeTIME COMPLETED:
01:30 PM
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01/12/2023 12:00 PM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility to conduct their scheduled pre-licensing inspection. Prior to initiating the annual inspection LPA completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 mask, gloves. LPA met with Licensee Ashley Phelps, and administrators Tamra Leak, and Lauren Leak, and administrative assistant Tiffany England and explained the purpose of the visit.

LPA toured the facility inside and out. The inside of the facility was observed to be generally in good condition and repair. The facility has received fire clearance for four (4) clients. The facility has four (4) bedrooms which all may be used for non-ambulatory clients. The facility has two (2) bathrooms which are in good condition and ready for use. There is one (1) bathroom and bedroom that will be used as a staff room/office that will be remodelled before clients move into the facility. Client and staff files will be stored in this locked room.



Adjacent to the staff room is the laundry area. The laundry room is currently being re-tiled and the new washer and dryer are currently in storage, and will be re-installed after the tile has been installed in the laundry room. This will be completed before clients move in. The laundry room, staff room/office are inaccessible to clients.

To ensure social distancing during meals the licensee will have 2 clients sit at the breakfast bar and 2 clients sit at a table that is in the living room. LPA observed these furnishings in place. LPA observed 4 easy chairs and one couch in the common area.

Client room #4 has one step down and currently no hand rail. Licensee has the hand rail in the bedroom and states it will be installed before clients are moved into the facility.

Continued on LIC809-C

SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE: DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/12/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: LIBERTY
FACILITY NUMBER: 525002968
VISIT DATE: 01/12/2023
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Food storage meets Title 22 regulation requirements. Plates, utensils, pots, and pans were in place during the inspection. Dishwasher, stove, microwave and refrigerator were all present.

The facility has (1) fully charged fire extinguisher which was inspected by the fire marshal. LPA observed smoke alarms and carbon monoxide detectors fully functioning. Bedrooms were observed to have furniture as required by Title 22 Regulations. All beds were made up with linens and bedspreads. Each client room has towels and face cloths available for the clients to use.


Storage and lighting are adequate in the home. Medications are to be locked up in a cabinet in the kitchen. Cleaning supplies and toxins will be locked up in a cabinet in the kitchen. Also locked in the kitchen are knives. Laundry area has locking cabinets for laundry supplies.

At the time of inspection there were window screens present but needed to be re-installed. Licensee agrees to install the window screens. Licensee will install night lights in hallways.

The front and back yards have been prepared for the installation of sod and landscaping. Licensee is waiting for the recent rain storms to abate before the sod is installed and landscaping is completed.

The facility currently has Covid 19 precautions in place. The facility also has proper screening for all staff visitors and clients.

Technical assistance was provided during the inspection. Licensee will contact LPA when all technical assistance items have been addressed. These items shall be completed before clients move into the facility.

The applicant has passed the pre-licensing portion of the application process.. LPA will contact the Central Application Bureau.

Exit Interview and copy of report was provided to the licensee.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023
LIC809 (FAS) - (06/04)
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