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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 075600483
Report Date: 05/17/2023
Date Signed: 05/17/2023 03:12:17 PM

Document Has Been Signed on 05/17/2023 03:12 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:CENTER FOR ADAPTIVE LEARNINGFACILITY NUMBER:
075600483
ADMINISTRATOR:BECKY WEIRINGAFACILITY TYPE:
775
ADDRESS:3227 CLAYTON ROADTELEPHONE:
(925) 827-3863
CITY:CONCORDSTATE: CAZIP CODE:
94519
CAPACITY: 48CENSUS: 6DATE:
05/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:11 AM
MET WITH:Becky Wieringa, Associate Director TIME COMPLETED:
03:25 PM
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On 11/17/2023 at 11:11 am Licensing Program Analysts (LPA) J. Clancy-Czuleger arrived unannounced to do an annual inspection. LPA meet with Becky Wieringa, Associate Director and explained the purpose of the visit.

LPA inspected the facility inside out. There is no body of water. Physical plant is consistent with the facility sketch received by Central Application Bureau (CAB) and approved by the fire department. LPA inspected the group gathering rooms, offices, dining area, kitchen, hallways, bathrooms, garden. There is a comfortable room temperature of 69 degrees Fahrenheit for clients in care. Facility was observed equipped with refrigerator, microwave, dishwasher. Clients bring their own lunches and snacks to facility. The hot water temperature in the client bathroom measured 115.1 degrees Fahrenheit. All observed toilets and hand washing stations are maintained in a safe, sanitary, operating condition. Cabinet for knives, cleaning supplies, and central storage for medications were observed with locks. Activity supplies were available. Outdoor activity space was observed furnished with tables, chairs and shade. The facility has a mitigation plan. Fire extinguishers were observed fully charge and tags showed serviced 01/18/2023. First aid kit was checked and is complete.

Continued on 809C...
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2023
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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: CENTER FOR ADAPTIVE LEARNING
FACILITY NUMBER: 075600483
VISIT DATE: 05/17/2023
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The following forms to be updated and submitted to CCLD:
  • LIC 610D Emergency Disaster Plan

At 11:50 am LPA reviewed 5 residents records. At 12:55 pm, LPA reviewed 5 staff records and 5 of 5 were fingerprint cleared and associated to the facility.

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023
LIC809 (FAS) - (06/04)
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