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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315001890
Report Date: 09/08/2022
Date Signed: 09/08/2022 11:18:20 AM

Document Has Been Signed on 09/08/2022 11:18 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:LINCOLN VILLA LLCFACILITY NUMBER:
315001890
ADMINISTRATOR:KUMAR, ALPESHFACILITY TYPE:
740
ADDRESS:2544 FLORADALE WAYTELEPHONE:
(916) 409-0979
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY: 6CENSUS: 6DATE:
09/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Alpesh KumarTIME COMPLETED:
11:30 AM
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LPA Parks arrived on Thursday September 8, 2022 to conduct the annual inspection. Prior to the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 mask.

LPA completed the infection control domain with Administrator and facility was found to be in substantial compliance. LPA and Administrator toured the facility together to ensure health and safety of residents in care.

LPA requested copies of current LIC500 and LIC610 to be sent to the Department by the end of the month. LPA obtained a copy of the current liability insurance.

No deficiencies are being cited as a result of todays visit. Exit interview conducted. A copy of this report was left at the facility.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Melissa Parks
LICENSING EVALUATOR SIGNATURE: DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2022
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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