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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340300556
Report Date: 07/29/2024
Date Signed: 11/08/2024 11:20:22 AM

Document Has Been Signed on 11/08/2024 11:20 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: 65DATE:
07/29/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Augusta OsayandeTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
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THIS REPORT IS AMENDED TO CHANGE THE TYPE OF VISIT. THIS IS A CASE MANAGEMENT - INCIDENT REPORT. DIRECTOR AGREED TO AMENDMENT TODAY 11/8/2024. Garrett Keisler, Program Director will sign todays report.

Licensing Program Analyst (LPA) Victoria Brown arrived 7/29/24 at 9am to conduct an investigation regarding incident reports received by Community Care Licensing (CCL). LPA met with Augusta Osayande and stated the purpose of the visit.

The incidents of potential monies missing occurred between 6/18/24 - 7/5/24.

LPA received a copy of the client record that provides the dates, credits, and debit as well as the balance of monies that is maintained at the bank for them.

LPA also received a list of staff who worked in the class during the incident(s).

LPA conducted interviews of staff #1 (S1-S3) during this visit.

These incidents need further investigation.

LPA will return on a later date to conclude.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Victoria Brown
LICENSING EVALUATOR SIGNATURE: DATE: 07/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/29/2024
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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