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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002910
Report Date: 08/31/2023
Date Signed: 09/01/2023 10:43:25 AM

Document Has Been Signed on 09/01/2023 10:43 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ADULT ACHIEVEMENT CENTERFACILITY NUMBER:
315002910
ADMINISTRATOR:DIXON, KYRAFACILITY TYPE:
775
ADDRESS:3217 PROFESSIONAL DRTELEPHONE:
(530) 878-8912
CITY:AUBURNSTATE: CAZIP CODE:
95602
CAPACITY: 69CENSUS: 48DATE:
08/31/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Kyra Dixon, AdministratorTIME COMPLETED:
01:30 PM
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On 8/31/2023 LPA Tryon visited the program to conduct a required annual review. LPA met with Kyra Dixon. The program currently has 48 participants all together.

LPA toured the program site including classrooms, kitchen, "rest" room where people can go if they don't feel well, bathrooms, offices, etc. The program appears to be clean, building and furnishings are in good shape, furniture and supplies are appropriate to meet the needs of the program.

LPA reviewed 5 of 48 client files and 2 of 4 staff files. Files contain appropriate documentation.

LPA reviewed the CARE Tool with Administrator.

At this time, the program appears to be in substantial compliance with the regulations. No deficiencies were cited at this visit.

Exit interview conducted.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Todd Tryon
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2023
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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