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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 585002569
Report Date: 01/19/2023
Date Signed: 01/19/2023 11:34:23 AM

Document Has Been Signed on 01/19/2023 11:34 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:GUANZON'S RESIDENTIAL CARE #3FACILITY NUMBER:
585002569
ADMINISTRATOR:GUANZON, LORENAFACILITY TYPE:
735
ADDRESS:5932 VINE COURTTELEPHONE:
(530) 741-0891
CITY:MARYSVILLESTATE: CAZIP CODE:
95901
CAPACITY: 4CENSUS: 4DATE:
01/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Lorena GuanzonTIME COMPLETED:
11:40 AM
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LPA Hiratsuka, conducted this unannounced annual visit. LPA wore a surgical mask and observed Administrator wearing one.

The main entrance opens to a sitting room on the left. To the right is a doorway leading to the kitchen and to the right of the kitchen is a second sitting area, shared resident room, and door leading to the backyard. The kitchen has a door leading to the garage. In the back of the first sitting area is a hallway leading to two private resident rooms, a full common bathroom, and a caregiver room. The caregiver room has a full private bathroom. In the backyard there is a locked shed. There are locked cabinets for medications, confidential files, and chemicals. Food supply and personal protection equipment meets regulations.

Multiple topics were discussed.

No deficiencies cited.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE: DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/19/2023
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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