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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200984
Report Date: 11/29/2021
Date Signed: 11/29/2021 10:40:31 AM

Document Has Been Signed on 11/29/2021 10:40 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:FUTURES EXPLORED, INC.FACILITY NUMBER:
079200984
ADMINISTRATOR:HACKETT, HEATHERFACILITY TYPE:
775
ADDRESS:1140 GALAXY WAY, STE 180TELEPHONE:
(925) 284-3240
CITY:CONCORDSTATE: CAZIP CODE:
94520
CAPACITY: 30CENSUS: 20DATE:
11/29/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:22 AM
MET WITH:Program Coordinator , Scott Brooks TIME COMPLETED:
10:45 AM
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On 11/29/2021 at 9:22AM, Licensing Program Analyst (LPA) J. Clancy-Czuleger arrived unannounced to conduct an Infection Control Inspection. LPA met with Program Coordinator, Scott Brooks and explained the purpose of the visit.

Upon entry, LPA observed that day program was conducting in-person services. LPA toured facility including but not limited to common areas, bathrooms, and kitchen. LPA observed facility has posted signs regarding cough etiquette and infection control protocol posted at the entrance. All hand washing stations were equipped with soap and paper towels. Facility has a daily health screenings with all staff, clients, and visitors.

During record review, LPA observed facility has a copy of Mitigation Plan on file. LPA observed PPE, soap, and paper supplies are sufficient. Facility documents all temperature screening and visitation log.


Exit interview conducted. A copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Jill Clancy-Czuleger
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2021
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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