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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002973
Report Date: 12/13/2022
Date Signed: 12/13/2022 04:14:17 PM

Document Has Been Signed on 12/13/2022 04:14 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:MORGAN CREEK VILLAFACILITY NUMBER:
315002973
ADMINISTRATOR:KING, ROBERTFACILITY TYPE:
740
ADDRESS:9565 PINEHURST DRIVETELEPHONE:
(916) 846-3169
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY: 6CENSUS: DATE:
12/13/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Robert KingTIME COMPLETED:
04:20 PM
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Licensing Program Analyst (LPA) K. Hiratsuka, arrived at the facility announced on 12/13/2022 to conduct a pre-licensing visit. LPA met with Applicant Robert King and explained the purpose of the visit. LPA wore a surgical mask and observed all staff wearing them too.

This facility has four private resident rooms, one shared resident room, and one staff room. The shared room has a full private bathroom. This facility has a fire clearance for six non-ambulatory residents. The main entrance opens into a foyer. There is a resident room directly to the left of the main entrance that has a full private bathroom. There is a sitting and dining room just past the resident room on the left. There is a resident room on the right of the main entrance that also has an exit to the outside. There is a hallway on the left past the sitting area that leads to three resident rooms, one staff room, one full common bathroom, locked laundry room, and locked storage closet. The staff room has a direct exit to the outside. The kitchen, a dining area, and main sitting area is towards the back of the facility. The backyard was inspected. There is a covered patio and a sitting area on one side of the facility. The garage is only accessible from the outside. There are locked cabinets in the kitchen for cleaning toxins and sharp knives. There is a nook between the kitchen and hallway leading to the resident rooms that stores medications. This facility has cameras located in the common areas that are visual only.

LPA waived Comp III because Applicant operates another facility.

Several topics were discussed.


This facility meets licensing requirements. LPA is going to submit this to applications specialist.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2022
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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