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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347003472
Report Date: 12/30/2022
Date Signed: 12/30/2022 01:52:55 PM

Document Has Been Signed on 12/30/2022 01:52 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:CORNELIA'S RCFEFACILITY NUMBER:
347003472
ADMINISTRATOR:CORNELIA CATAFACILITY TYPE:
740
ADDRESS:5422 NORTH AVENUETELEPHONE:
(916) 489-3299
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY: 6CENSUS: 6DATE:
12/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Cornelia Cata and Rodica CataTIME COMPLETED:
02:15 PM
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On 12/30/2022, Licensing Program Analyst (LPA) Cassie Yang arrived at the facility to conduct an annual inspection. LPA met with Licensee and explained the purpose of the visit. LPA observed the license posted to not match the license on file. LPA printed and signed the updated license for Licensee to post in a prominent place.

LPA and Licensee toured in the interior of the facility to ensure the health and safety of residents in care. In areas toured, no immediate health and safety risk were observed. LPA observed Administrator Certificate #6025206740 and #6061082740 to be up to date.

LPA observed the facility to be in adequate temperature of 75 degrees. LPA observed 6 out of 6 residents room to be free of medication, toxic and sharps. LPA observed the facility to have 30+ days of Personal Protective Equipment and linens, 2+ days of perishable food, and 7+ days non-perishables. Licensee reported no concerns at the facility.

During today's visit, LPA obtained copies to the liability insurance and Administrator Certificate. As a result of today's inspection, no deficiencies were observed.

Exit interview conducted and a copy of the report was left at the facility.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 12/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/30/2022
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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