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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317005526
Report Date: 02/15/2024
Date Signed: 02/15/2024 10:15:52 AM

Document Has Been Signed on 02/15/2024 10:15 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:REACH ADULT DEVELOPMENT SITE #4FACILITY NUMBER:
317005526
ADMINISTRATOR:SUH, SEANFACILITY TYPE:
775
ADDRESS:1140 SUNSET BLVD STE 145TELEPHONE:
(916) 616-0729
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY: 30CENSUS: 16DATE:
02/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:14 AM
MET WITH:Orlando Areizaga, DirectorTIME COMPLETED:
10:20 AM
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On 2/15/2024, Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced to conduct a Required- 1 Year Inspection utilizing the CARE Tool. LPA met with Director, Orlando Areizaga, and explained the purpose of the visit. The program offers various activities for the clients including arts and crafts, cooking, computer, music, and learning/ job skills training.

The facility has two large class rooms, a large multipurpose room, a computer room, kitchen area, general purpose area and two bathrooms. LPA and Director toured the interior and exterior of the facility to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, bathrooms, and kitchen. The last fire drill was conducted on 2/14/2024. The fire extinguishers were serviced, charged, and functional on 6/5/2023. All chemicals and medications were locked and secured. First aid was completed. Hot water temperature was measured in the bathroom at 117 degrees F.

LPA reviewed a total of three (3) client files. Client files contain signed admission agreements, physician's reports, and IPP. LPA reviewed a total of two (2) staff records and all documentation was present including first aid, fingerprint clearance, and health screening.

During today's visit no deficiencies are being cite.

Exit interview conducted and report provided.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Sarena Keosavang
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2024
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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