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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525002754
Report Date: 04/14/2022
Date Signed: 04/14/2022 10:13:40 AM

Document Has Been Signed on 04/14/2022 10:13 AM - 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:PLEASANT PLACEFACILITY NUMBER:
525002754
ADMINISTRATOR:MARSHALL, ALLAN A.FACILITY TYPE:
740
ADDRESS:411 HYLAND DRIVETELEPHONE:
(530) 838-9244
CITY:CORNINGSTATE: CAZIP CODE:
96021
CAPACITY: 5CENSUS: 4DATE:
04/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee Cynthia MarshallTIME COMPLETED:
10:30 AM
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Licensing Program Analysts (LPA) Jaclyn Avila and David Loperena, arrived at the facility unannounced on 04/14/2022 to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with Licensee Cynthia Marshall, and explained the purpose of the visit. Prior to initiating the annual inspection 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. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95

LPA and Licensee toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, common bathroom, and garage. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Licensee completed the infection control domain and facility was found to be in substantial compliance at this time.

A couple of topics were discussed.


No deficiencies are being cited as a result of todays inspection.

Exit interview conducted and copy of report left at the facility.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Jaclyn Avila
LICENSING EVALUATOR SIGNATURE: DATE: 04/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/14/2022
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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