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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 585002772
Report Date: 01/05/2023
Date Signed: 01/05/2023 03:12:04 PM

Document Has Been Signed on 01/05/2023 03:12 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:AAVON CARE HOME 2FACILITY NUMBER:
585002772
ADMINISTRATOR:BAL, JAGDEEPFACILITY TYPE:
735
ADDRESS:5555 HARCREST DR.TELEPHONE:
(530) 701-4037
CITY:MARYSVILLESTATE: CAZIP CODE:
95901
CAPACITY: 4CENSUS: 4DATE:
01/05/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Cindy MunozTIME COMPLETED:
03:20 PM
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LPA Hiratsuka conducted this unannounced annual visit. LPA wore a surgical mask and observed all staff wearing surgical masks. LPA was screened at the front door by Caregiver.

The main entrance opens to a hallway. To the left of the main entrance are two private resident rooms and one full common bathroom. To the right of the main entrance is a door leading to the garage. Towards the back of the facility is the main common area that has the kitchen, dining, and sitting area. To the right of of the main common area is a hallway leading to two private resident rooms that have their own full private bathrooms, and there is a laundry room. There are locked closets and cabinets for sharps, medications, files, and staff items.

One staff file and one resident file were reviewed.

A couple of topics were reviewed.

No deficiencies cited.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE: DATE: 01/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/05/2023
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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