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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700613
Report Date: 04/22/2022
Date Signed: 04/22/2022 05:01:23 PM

Document Has Been Signed on 04/22/2022 05:01 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:CASTLE OASIS HOME CARE LLCFACILITY NUMBER:
342700613
ADMINISTRATOR:NICHOLS, GARYFACILITY TYPE:
740
ADDRESS:5205 CASTLE STTELEPHONE:
(916) 865-7726
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY: 6CENSUS: 5DATE:
04/22/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Roza Nichols, caregiver TIME COMPLETED:
05:00 PM
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
Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection. LPA met with Roza Nichols, caregiver, who contacted Administrator, Gary, who arrived at 4:10 pm. LPA explained purpose of inspection. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols and confirmed the facility does not currently have any positive Covid-19 diagnoses. Additionally, LPA was screened per Covid-19 precautionary measures upon entering the community. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: KN95 mask. Facility currently has (5) residents and (3) residents are on hospice.

LPA discussed the reason for the inspection with the Licensee by phone who is currently out of town. LPA assisted Licensee in paying a late fee that was assessed related to annual fees during today's inspection and was provided with a confirmation number. Licensee confirmed annual fees were paid but was not aware of late fee due.

LPA also discussed Licensee's related facility and provided balance/PIN information as well. Licensee stated a bill was not received.

LPA toured the interior and exterior of the facility with Administrator. LPA observed the facility to be clean, in good repair and to not pose any health and safety hazard to residents.

There are no deficiencies cited during today's inspection.

Exit interview. Copy of report provided to Administrator.



SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 04/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/22/2022
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