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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 086803799
Report Date: 04/19/2023
Date Signed: 04/19/2023 02:51:36 PM

Document Has Been Signed on 04/19/2023 02:51 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:G.H. OUTREACH OF DEL NORTEFACILITY NUMBER:
086803799
ADMINISTRATOR:WALTERS, JEFFERYFACILITY TYPE:
775
ADDRESS:700 E WASHINGTON BLVDTELEPHONE:
(707) 464-5089
CITY:CRESCENT CITYSTATE: CAZIP CODE:
95531
CAPACITY: 30CENSUS: 18DATE:
04/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Jeffery WaltersTIME COMPLETED:
03:00 PM
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At approximately 12:30PM, Licensing Program Analyst (LPA) Chris Arnhold arrived unannounced at this Licensed Day Program to conduct an Annual Required Inspection. LPA met with Administrator Jeffery Walters and toured the facility. This Day Program operates Monday -Friday. There were 18 Clients and 7 Staff present at the time of this inspection. The facility consists of offices, a large activity space, maintenance garage, a quiet room, a kitchen, and three bathrooms. LPA observed the facility was a comfortable temperature and found all exits and walkways to be unobstructed. The facility grounds were also kept clean and without hazards. Clients bring lunches and snacks.
Toxins are centrally stored in a locked closet of the facility. Water temperature measured within regulation between 105 and 120 degrees at faucets accessible to clients. Client money is not handled by facility. Day Program staff do not handle or dispense medication. Clients do recycling and lawn care tasks which enables clients a chance to interact with the community. The paper shredding area was clean and orderly. Clients receive training prior to working at each location. At approximately 1:15PM, LPA reviewed 5 of 18 client files and found files to be thorough and contain current client care assessments and individualized Service Plans. LPA reviewed 5 of 5 staff records and found them to be current, including staff first aid and CPR training verification. Disaster drills are conducted every 6 months.
Updated copies of the following documents were requested during visit to update facility file:
LIC500- Personnel Report
LIC610D- Disaster Plan

No citations issued during this visit.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE: DATE: 04/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/19/2023
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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