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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045002577
Report Date: 12/16/2024
Date Signed: 12/16/2024 02:35:00 PM

Document Has Been Signed on 12/16/2024 02:35 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:SOARFACILITY NUMBER:
045002577
ADMINISTRATOR/
DIRECTOR:		YOKOTA, YULIKOFACILITY TYPE:
775
ADDRESS:3760 MORROW LN STE FTELEPHONE:
(530) 898-0813
CITY:CHICOSTATE: CAZIP CODE:
95928
CAPACITY: 6CENSUS: 2DATE:
12/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Consultant/Staff Member, Anita WagnerTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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On December 16, 2024 at approximately 1:15 PM, Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Soar Day Program for the purpose of conducting a Required 1 year inspection. LPA was greeted at the door by Consultant/Staff Member, Anita Wagner and was granted access into the facility.

LPA and the Consultant/Staff Member toured the facility. LPA observed the Day Program to be clean, safe and sanitary with all exits free from obstruction. LPA observed an activity room, a separate sensory room, chemical supply room that is locked and inaccessible to clients in care, a kitchen, another activity room in the far back of the facility. Shaded Outdoor activity space was observed. Fire Extinguishers was last inspected on June 2024. Carbon monoxide detector was tested and found to be operational at the time of the inspection. Smoke Detectors were tested and found to be operational during the inspection. Hot water temperature measured at 109 degrees in 1 of 1 bathrooms. Hot water temperature is within acceptable range of 105-120 degrees. Food is not served at the Day Program. Clients bring their own lunches. Facility does store medications at the facility and dispense medications. Medication review of 1 of 1 client file was conducted and found to be appropriate. Toxins are kept locked and inaccessible to clients in care. Facility has a first aid kit which was inspected and found to be appropriate during the inspection. There is an outdoor space for activities with a shaded area. During the Required 1 year inspection, LPA reviewed the Infection Control Plan and found that document to be appropriate. LPA advised facility to contact County Public Health and Community Care Licensing immediately if symptoms of COVID-19 + or any infectious diseases in the facility. Emergency Disaster Plan was reviewed and found to be appropriate during the review. Last disaster drill was conducted in June 2024.

During a staff file review, LPA observed that the Administrator does not have the minimum number of clock hour training's annually (See LIC 9102-Technical Violation) First aid certificates were reviewed and found to be appropriate. (Report continued on LIC 809C)
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SOAR
FACILITY NUMBER: 045002577
VISIT DATE: 12/16/2024
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 LPA reviewed the 2 of 2 staff files and found that the facility staff do not have all their hours of training (See LIC 9102-Technical Violation). LPA educated the staff member on the importance of ensuring that ALL staff members including the Administrator have the required annual training's as outlined in Title 22 Regulations. 2 of 2 client files were reviewed and found that the LIC 602/Physicians Assessment Reports were not retained in the client files (See LIC 9102-Technical Assistance). LPA educated the Consultant/Staff Member on the importance of ensuring that ALL client records are complete.

LPA requested the following documents:

LIC 500-Personnel Report
LIC 308-Designation of Responsibility
LIC 400- Affidavit regarding Client Cash Resources
Liability insurance
Control of Property
Client Roster

No deficiencies were cited during the Required 1 year inspection. Exit interview was conducted and a copy of this report was signed and given to the Consultant/Staff Member.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
LIC809 (FAS) - (06/04)
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