<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340300556
Report Date: 11/08/2024
Date Signed: 11/08/2024 11:31:22 AM

Document Has Been Signed on 11/08/2024 11:31 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ELK GROVE ADULT COMMUNITY TRAINING, INC.FACILITY NUMBER:
340300556
ADMINISTRATOR/
DIRECTOR:		JOE JAQUEZFACILITY TYPE:
775
ADDRESS:8810 ELK GROVE BLVD.TELEPHONE:
(916) 685-7666
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 160CENSUS: 64DATE:
11/08/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Garrett Keisler, Program Director,TIME VISIT/
INSPECTION COMPLETED:
11:30 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 11/8/24 at 8:30am to conduct a Case Management visit on a subsequent visit. LPA met with Garrett Keisler, Program Director and stated the purpose of the visit. Garrett Keisler, Program Director, contacted the Administrator Joe Jaquez regarding todays visit as well.

On 7/29/24, LPA conducted an investigation regarding incident reports received by Community Care Licensing (CCL). LPA met with Augusta Osayande. The incidents of potential monies missing occurred between 6/18/24 - 7/5/24. During the investigation of the incident, LPA requested a list of staff and their contact information. LPA received a sticky note with staff names who worked in the classrooms on the dates the monies became missing 6/18/24, 6/28/24, and 7/5/24. The Administrator took a photo of the sticky notes that were given to LPA. LPA asked again for the staff contact information. The Administrator stated that she would not provide that information to LPA. In addition, the Administrator called the staff on a work cell phone on speaker to be interviewed by LPA regarding the incident. LPA inquired if the staff were in a position to have a confidential conversation and provided her phone number for a call back.

During this visit with Garrett Keisler, Program Director, it was stated that the program do not give out confidential information. LPA advised HIPAA does not apply to Community Care Licensing (CCL). LPA provided a copy of the Senate Bill No. 1377 Chapter 664 which Garrett Keisler, Program Director made the copy for the facility during this visit. LPA spoke with Administrator Joe Jaquez regarding todays visit, the circumstances that occurred and both agreed upon the plan of correction.
Based on the refusal of the Administrator to provide staff records during an investigation this shall be cited.
Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, the following deficiencies are cited on the 809D. Licensee was provided a copy of their rights (LIC9058) and their signature acknowledges receipt of these rights.Exit interview held, a copy of report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Victoria Brown
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 11/08/2024 11:31 AM - It Cannot Be Edited


Created By: Victoria Brown On 11/08/2024 at 10:49 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: ELK GROVE ADULT COMMUNITY TRAINING, INC.
FACILITY NUMBER: 340300556

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/15/2024
Section Cited
CCR
82066(c)

1
2
3
4
5
6
7
Personnel Records All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours...
1
2
3
4
5
6
7
Licensee shall provide training to staff and submit documented proof to CCL along with a statement indicating this regulations shall be upheld at all times.
8
9
10
11
12
13
14
This requirement is not met as evidenced by:
Based on the licensee did not comply with the section cited above by refusing to provide staff contact information during an investigation which poses a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
Fax to CCL by POC due date 11/15/24
Type B
11/15/2024
Section Cited
CCR80044(b)(1)

1
2
3
4
5
6
7
Inspection Authority of the Licensing Agency
The licensing agency shall have the authority to interview clients, including children, or staff members, without prior consent. The licensee shall ensure that provisions are made for private interviews…
1
2
3
4
5
6
7
Licensee shall provide training to staff and submit documented proof to CCL along with a statement indicating this regulations shall be upheld at all times.
8
9
10
11
12
13
14
This requirement is not met as evidenced by:
Based on the licensee did not comply with the section cited above by contacting staff on a cell phone speaker to be interviewed by CCL regarding incident that occurred at the facility which poses a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
Fax to CCL by POC due date 11/15/24
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Stephen Richardson
LICENSING EVALUATOR NAME:Victoria Brown
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2024


LIC809 (FAS) - (06/04)
Page: 2 of 2