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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700469
Report Date: 10/31/2022
Date Signed: 10/31/2022 01:20:37 PM

Document Has Been Signed on 10/31/2022 01:20 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:GREAT HAVENFACILITY NUMBER:
342700469
ADMINISTRATOR:EZE, CHINYEREFACILITY TYPE:
740
ADDRESS:71 GROTH CIRTELEPHONE:
(916) 833-6388
CITY:SACRAMENTOSTATE: CAZIP CODE:
95834
CAPACITY: 6CENSUS: 0DATE:
10/31/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:54 PM
MET WITH:Chinyere Eze, LicenseeTIME COMPLETED:
01:40 PM
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On October 31, 2022, at 1pm, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived to conduct the Annual required inspection. LPA met with the Licensee, Chinyere Eze, and informed her the reason for the visit. Prior to initiating 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, and completed a facility risk assessment. LPA ensured she applied hand sanitizer before entering the facility and worn a mask for the Personal Protective Equipment (PPE).

Chinyere and LPA completed the inspection tool questionnaire with no issues or advisories to report.
The facility has no residents at this time.
LPA observed the following:
Administrator certificate is valid. First aid kit fully stocked and ready for emergency use. Fire extinguishers fully charged. First Facility was 67 degrees F.
Common areas were clean and in good repair. Bedrooms had required furniture and lighting. Smoke alarms and carbon monoxide detectors were working.

As a result of this visit, no deficiencies were cited, per Title 22 Regulations, Division 6.

Exit interview conducted and a copy of this report given to Chinyere EZE.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons
LICENSING EVALUATOR SIGNATURE: DATE: 10/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2022
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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