<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 585002962
Report Date: 12/29/2022
Date Signed: 12/29/2022 09:00:12 AM

Document Has Been Signed on 12/29/2022 09:00 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:M & L CAREHOME 2FACILITY NUMBER:
585002962
ADMINISTRATOR:AGATI, MAXIMFACILITY TYPE:
735
ADDRESS:2064 NEWPORT COURTTELEPHONE:
(530) 443-2958
CITY:PLUMAS LAKESTATE: CAZIP CODE:
95961
CAPACITY: 4CENSUS: 0DATE:
12/29/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Leah AguirreTIME COMPLETED:
09:10 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
LPA Hiratsuka, conducted this announced prelicensing visit. LPA wore a surgical mask and facility representative did as well. Applicant was unable to make this visit but he sent an authorized representative.

This facility has a fire clearance for three ambulatory and one non-ambulatory residents. The main entrance opens into a small foyer. To the immediate left of the entrance is the non-ambulatory room and a full common bathroom. To the right of the main entrance leads to the rest of the facility. It opens to a large common area and kitchen. To the right of the main common area is a hallway leading to three private resident rooms, one full common bathroom, laundry room that leads to the garage, and one staff room. The staff room has a full private bathroom. There are locked cabinets in the kitchen for medications and sharps. There is a door leading to the backyard from the main common area. The gate is on the same side as the garage.

LPA is waiving the component III orientation because Applicant and Facility Representative own and operate several other facilities.

This facility does meet regulations and LPA is going to submit this report to the application specialist.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE: DATE: 12/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/29/2022
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 1