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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700761
Report Date: 11/30/2022
Date Signed: 11/30/2022 04:50:22 PM

Document Has Been Signed on 11/30/2022 04:50 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:SPLENDOR OAKS SENIOR LIVING 1FACILITY NUMBER:
342700761
ADMINISTRATOR:LEE, KEVINFACILITY TYPE:
740
ADDRESS:3609 VOLEYN STTELEPHONE:
(916) 993-9921
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 6CENSUS: 6DATE:
11/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Tameka StewartTIME COMPLETED:
05:05 PM
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On 11/30/2022, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a required 1-yr annual inspection. LPA met with Caregiver, Tameka Stewart, and explained the purpose of the visit. LPA spoke on the phone with Administrator, Maria Cucicea, who informed LPA she was unavailable to come to the facility but caregivers are designated on the LIC 308. LPA observed and confirmed the LIC 308. Prior to today's inspection, LPA ensured she applied hand sanitizer and the following Personal Protective Equipment (PPE) was worn: surgical mask. The facility currently has (6) residents and (2) residents on hospice services. The facility has an approved hospice waiver of two (2).

LPA and caregiver toured the interior of the facility including bathroom, (6) resident bedrooms, laundry room, medication room, kitchen, garage and common areas. LPA observed (3) residents to be in the common area watching television, and (3) residents to be in their private rooms. In the areas toured, no immediate health and safety risk were observed. LPA observed the facility to be supplied with 2+ days of perishables and 7+ days of non-perishable food. Fire extinguishers was observed to be last serviced on 5/16/2022. LPA observed the facility to have COVID-19 signs to be posted throughout the facility. LPA observed sharps, toxics and medication to be locked and secured. LPA observed two Administrator Certificate posted (#6053688740 and #6008780740), both are up to date. LPA advised facility to have all trash can with lid in the bathrooms. At this time the facility was found to be at substantial compliance.

LPA requested the following documents to be emailed to LPA Yang by Friday December 9, 2022 : Administrator Certificate, LIC 500, LIC 308 and current liability insurance.

As a result of today's inspection, no deficiencies were observed.

Exit interview was conducted. A copy of report was left at facility.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2022
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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