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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700054
Report Date: 05/03/2023
Date Signed: 05/03/2023 03:11:51 PM

Document Has Been Signed on 05/03/2023 03:11 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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME:ADULT VOCATIONAL SERVICES INCFACILITY NUMBER:
312700054
ADMINISTRATOR:SUH, SEANFACILITY TYPE:
775
ADDRESS:3845 ATHERTON RD #7TELEPHONE:
(916) 204-5726
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY: 30CENSUS: 21DATE:
05/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Nati Mauga, Program DirectorTIME COMPLETED:
03:20 PM
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Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to conduct an annual inspection. LPA met with Nati Mauga during today's inspection. During today's inspection there were 21 clients attending program.

LPA toured the facility with the administrator. LPA observed common activity rooms, kitchen area, and bathrooms. Emergency exit was clear and accessible. In the areas toured no immediate health, safety, or personal rights violations were observed. The facility appeared to be clean and free from odors. There is a locked area for toxins and clients bring their own lunch to program.

LPA reviewed 3 client files and 3 staff files. Facility does not have clients that require medication services. A review of staff records indicates that all facility staff have received criminal record clearances and/or are associated to this facility. Staff records reviewed indicated current first aid and CPR certificates and training is being completed.

No deficiencies are being cited as a result of todays inspection.

Exit interview conducted.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Bethany Mirlohi
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2023
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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