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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317004491
Report Date: 02/03/2023
Date Signed: 02/03/2023 09:51:09 AM

Document Has Been Signed on 02/03/2023 09:51 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:ADULT DAY EXPERIENCES (ADE)FACILITY NUMBER:
317004491
ADMINISTRATOR:ASHLI KACKLEFACILITY TYPE:
775
ADDRESS:2510 WARREN DRIVE, SUITE ATELEPHONE:
(916) 632-2332
CITY:ROCKLINSTATE: CAZIP CODE:
95677
CAPACITY: 30CENSUS: 17DATE:
02/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Administrator -Suzanne BaskervilleTIME COMPLETED:
09:50 AM
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Licensing Program Analyst (LPA) Bains arrived at the facility unannounced on 02/03/2023 to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with Administrator -Suzanne Baskerville and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, the daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms, and contacted facility to complete a facility risk assessment. LPA wore the following Personal Protective Equipment (PPE) during today's visit: surgical mask. LPA was screened by staff upon entry.

LPA and administrator toured facility together to ensure the health and safety of clients in care. Areas toured include but are not limited to: common areas, 1 exercise room, 5 classrooms , two (2) bathrooms, staff break room and storage. In the areas toured no immediate health, safety, or personal rights violations were observed.

LPA and administrator completed the infection control domain together and facility was found to be in substantial compliance at this time.

No deficiencies are being cited as a result of today's inspection.
Exit interview conducted and copy of report left at the facility.



SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE: DATE: 02/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2023
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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