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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317005272
Report Date: 08/26/2021
Date Signed: 08/26/2021 02:04:22 PM

Document Has Been Signed on 08/26/2021 02:04 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:ADULT DAY EXPERIENCES TOOFACILITY NUMBER:
317005272
ADMINISTRATOR:ASHLI E. KACKLEFACILITY TYPE:
775
ADDRESS:2520 WARREN DRIVE, STE BTELEPHONE:
(916) 251-7250
CITY:ROCKLINSTATE: CAZIP CODE:
95677
CAPACITY: 30CENSUS: 10DATE:
08/26/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Ashli Kackle, administratorTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Wolter arrived at the facility unannounced to conduct Required-1 Year Inspection utilizing the infection control domain, LPA met with administrator Ashli Kackle and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA also contacted licensee and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. Additionally, LPA was screened by facility staff upon arrival.

LPA and administrator toured facility together to ensure health and safety of clients in care. Areas toured include but are not limited to: classrooms, bathrooms, storage area, outdoor area, isolation room, and office. 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 todays inspection.
Exit interview conducted and copy of report to be emailed to administrator.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Danyle Wolter
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2021
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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