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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525002968
Report Date: 01/31/2023
Date Signed: 01/31/2023 10:30:52 AM

Document Has Been Signed on 01/31/2023 10:30 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: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:
01/31/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Ashley Phelps - licenseeTIME COMPLETED:
10:30 AM
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01/31/2023 10:00 AM Licensing Program Analyst (LPA) Rebecca Knight arrived at the facility to conduct a case management visit to ensure that technical advice items that had been discovered during the facility pre-licensing had been completed before the facility starts accepting clients. 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 explained the purpose of the visit. LPA and Ms. Phelps toured the facility together to ensure:

The laundry room tile has been installed, the washer and dryer have been placed and are functioning.


The front yard has been landscaped to include a parking area.
The back yard landscaping has been completed .
The facility has a functioning telephone.
All window screens have been installed.
Licensee has ensured that the fireplace will not be used.
The remodel of the office/staff room has been completed.
A handrail has been installed in client room #4 on the step down to the room.
Night lights have been installed in the hallways.

No deficiencies. Exit Interview and copy of report was provided to licensee Ashley Phelps.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2023
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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