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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700996
Report Date: 05/04/2021
Date Signed: 05/04/2021 03:15:35 PM

Document Has Been Signed on 05/04/2021 03:15 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
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:WELLQUEST GRANITE BAY TENANTCO LLCFACILITY NUMBER:
312700996
ADMINISTRATOR:MANOMHEHRI, PARIFACILITY TYPE:
740
ADDRESS:9747 SIERRA COLLEGE BLVDTELEPHONE:
(801) 815-0808
CITY:GRANITE BAYSTATE: CAZIP CODE:
95661
CAPACITY: 135CENSUS: 0DATE:
05/04/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Pari Manouchehri- AdministratorTIME COMPLETED:
03:30 PM
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On May 4, 2021 at 1:30PM, Licensing Program Analysts (LPAs) Sarena Keosavang and Jacob Williams conducted an announced Pre-Licensing Inspection. Both LPAs were cleared for field visits through screenings for COVID-19 prior to arriving at the facility and weekly COVID-19 tests. Both LPAs were screened prior to entry with the temperature within normal range. LPAs met with Administrator, Pari Manouchehri, and President, Dean Mattsson. LPAs were granted entry into the facility. LPAs observed staff wearing masks throughout the facility.

LPAs toured the indoor and outdoor premises with Administrator. The indoor and outdoor passageways were free of obstruction. The facility is a two story building with three courtyards. LPAs observed the facility's lobby area, kitchen, bedrooms, bathrooms, theater room, computer room, medication room, and courtyards. LPAs observed a swimming pool to be locked and inaccessible. LPAs observed required furniture, and lighting throughout the facility. First aid kit was completed with bandages, tweezers, scissors, and thermometer.

LPAs observed one fire extinguisher. Fire extinguisher is to be expired on January of 2022. LPAs observed fire detectors. LPAs observed required licensing postings located in the entrances area.

Component III presentation conducted with Administrator.

LPA observed that the facility is ready to be licensed. This report will be submitted to the Central Application Bureau (CAB) and final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAB. Additional requirements may still be required.

An exit interview was conducted with Administrator, Pari Manouchehri, and a copy of this report will be provided to the facility via email.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Jacob Williams
LICENSING EVALUATOR SIGNATURE: DATE: 05/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/04/2021
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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