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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 037000102
Report Date: 09/17/2024
Date Signed: 09/17/2024 12:28:12 PM

Document Has Been Signed on 09/17/2024 12:28 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ARC OF AMADOR/CALAVERASFACILITY NUMBER:
037000102
ADMINISTRATOR/
DIRECTOR:		KARYN GREGORIUSFACILITY TYPE:
775
ADDRESS:75 ACADEMY DRIVETELEPHONE:
(209) 267-5978
CITY:SUTTER CREEKSTATE: CAZIP CODE:
95685
CAPACITY: 45CENSUS: 42DATE:
09/17/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Karyn Gregorius and Lurali MooreTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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On 9/17/24 at 10:30am, Licensing Program Analyst (LPA) Arvin Villanueva arrived to the Day Program unannounced to conduct a Required Annual Visit. LPA met with Administrator Karyn Gregorius, and Lurali Moore, and explained the purpose of the visit.

LPA Villanueva inspected the physical plant with Karyn and Lurali to ensure compliance with Title 22 regulations. LPA observed 6 classrooms, common areas, 2 bathrooms, and the office area. Classrooms were observed to have necessary furniture, organized, and free from obstructions of any emergency exits. The exterior plant was observed to be free from debris. The exterior area has a shaded area for outdoor activities, a garden area, and a shed, which was observed to be locked due to holding chemicals and other storage items. The facility currently does not store medications nor provide medication administration assistance to participants. A first aid kit was inspected and observed to be complete. Sharps, cleaning supplies and other dangerous items were observed to be locked and inaccessible to participants. The program has six (6) transport vans for community activities. The facility temperature thermostat provided a reading of 73*F. Hot water was measured in the mens bathrooms at 114*F. LPA observed men's and women's bathrooms, both equipped with 2 toilets each providing individual privacy. LPA observed multiple fire extinguishers in the hallway and a pull alarm system. Fire extinguishers were last serviced on 6/6/24. Facility conducts drills at least monthly and last drill was conducted on 8/19/24.

LPA reviewed 4 client files and 4 staff files. 4 of 4 files were observed to be complete with criminal background clearance, current first aid/CPR certificates, up to date training for 2024. 4 of 4 client files were observed to have necessary documentation for program and emergency information. The facility has an emergency disaster plan and an infection control plan. Technical assistance was provided to update their infection control plan and ensure the plan is reviewed at least annually.

No health or safety concerns were observed during the visit. During the visit, staff were observed interacting with participants, completing paperwork, and leading class activities. Participants appeared to be engaged, happy, and socializing with peers.

LPA was provided with an updated LIC500 prior to visit. LPA requested an updated LIC308 to be emailed.

Per California Code of Regulations, Title 22, Division 6, Chapter 3, no deficiencies were observed during this visit. An exit interview was held with Administrator Karyn, and a copy of the report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/17/2024
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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