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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 086803799
Report Date: 03/03/2025
Date Signed: 03/03/2025 02:13:28 PM

Document Has Been Signed on 03/03/2025 02:13 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/
DIRECTOR:
WALTERS, JEFFERYFACILITY TYPE:
775
ADDRESS:700 E WASHINGTON BLVDTELEPHONE:
(707) 464-5089
CITY:CRESCENT CITYSTATE: CAZIP CODE:
95531
CAPACITY: 30CENSUS: 18DATE:
03/03/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Jeffery WaltersTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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At approximately 1:00PM, Licensing Program Analyst (LPA) Chris Arnhold arrived unannounced at this Licensed Day Program unannounced, to conduct an Annual Required Inspection. LPA met with Administrator Jeffery Walters and toured the facility. This Day Program operates Monday -Friday. 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 there own 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. Fire extinguishers were present and operational. Carbon monoxide detector was present. Smoke detectors were operational. Client money is not handled by facility. Day Program staff do not handle or dispense medication. Clients do recycling, paper shredding 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 1:30PM, LPA reviewed 5 client files and found files to be thorough and contain current client care assessments and individualized Service Plans. Staff records were reviewed and found 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 for facility file and are to be submitted to CCL within 30 days of this visit:
LIC500- Personnel Report
LIC610E- Disaster Plan

No citations issued during this visit.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Christopher Arnhold
LICENSING EVALUATOR SIGNATURE: DATE: 03/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/03/2025
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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