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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317005272
Report Date: 02/15/2022
Date Signed: 02/15/2022 12:42:46 PM

Document Has Been Signed on 02/15/2022 12:42 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: 30DATE:
02/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:LICENSEE-GAUDET, ADRIENETIME COMPLETED:
01:00 PM
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Licensing Program Analysts (LPAs) Talwinder Bains and Michael Hood arrived at the facility unannounced on 02/15/2022 to conduct a Required-1 Year Inspection utilizing the infection control domain. LPAs met with Licensee, Adriene Gaudet, and explained the purpose of the visit. Prior to initiating the annual inspection, LPAs 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. LPAs wore the following Personal Protective Equipment (PPE) during today's visit: N-95 masks.

LPAs and Licensee toured facility together to ensure the health and safety of clients in care. Areas toured include but are not limited to: kitchen, common areas, 3 classrooms , two (2) bathrooms, staff break room, office, and storage. In the areas toured no immediate health, safety, or personal rights violations were observed.

LPAs and Licensee 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: 02/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2022
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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