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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317005272
Report Date: 03/05/2025
Date Signed: 03/05/2025 12:19:17 PM

Document Has Been Signed on 03/05/2025 12:19 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, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ADULT DAY EXPERIENCES TOOFACILITY NUMBER:
317005272
ADMINISTRATOR/
DIRECTOR:		ASHLI E. KACKLEFACILITY TYPE:
775
ADDRESS:2520 WARREN DRIVE, STE BTELEPHONE:
(916) 251-7250
CITY:ROCKLINSTATE: CAZIP CODE:
95677
CAPACITY: 30CENSUS: 27DATE:
03/05/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Admin - Ashli KackleTIME VISIT/
INSPECTION COMPLETED:
12:05 PM
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Licensing Program Analyst (LPA) Graham Gunby arrived on Wednesday March 5, 2025 to conduct the unannounced annual inspection.

LPA met with Administrator Ashli and explained the purpose of the visit.

During today's visit, the Compliance and Regulatory Enforcement Tool was used. LPA reviewed (10) participant files and (5) staff files. All files contained the required paperwork.

LPA and Administrator toured facility together to ensure the health and safety of participants in care. Areas toured included classrooms, bathrooms, kitchen, and staff break room. In the areas toured no immediate health, safety, or personal rights violations were observed. Facility is current on fire drills. First Aid kit was fully stocked. Chemicals were kept locked an inaccessible to participants.


No deficiencies cited. Exit interview conducted and copy of report was emailed to the admin.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Graham Gunby
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2025
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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