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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340312462
Report Date: 10/03/2022
Date Signed: 10/03/2022 05:47:08 PM

Document Has Been Signed on 10/03/2022 05:47 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:ACE-IT IIFACILITY NUMBER:
340312462
ADMINISTRATOR:HARRIS, SUEFACILITY TYPE:
775
ADDRESS:8089 MADISON AVE, SUITE 4TELEPHONE:
(916) 962-2766
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 60CENSUS: 8DATE:
10/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Lacy De La FuenteTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived at the facility unannounced on 10/3/2022 to conduct a Required 1- Year Inspection utilizing the infection control domain. LPA met with Stephanie Howard, Assistant Program Director, and Administrator, Lacy De La Fuente, and explained the purpose of the visit. The facility is an Adult Day Program vendorized by Alta California Regional Center that is licensed to serve (60) adult/elderly developmentally disabled clients, (15) of whom may be non-ambulatory. LPA observed (8) clients to be present and (4) additional staff present. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms and contacted licensee and completed a facility risk assessment. LPA ensured he applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: KN95 mask. Additionally, LPA was screened by facility staff upon entering the facility.

LPA,Program Director and Assistant Program Director, toured the interior and exterior of the facility and observed it to be clean, safe and in good repair. The facility has designated areas for woodworking, learning corner, fitness, music, cooking, computers, art and free choice. Also there is a basketball court and picnic table outside. Staff ratio is 1:4. The program reopened 7/5/2022 after closing due to Covid-19 pandemic. LPA observed the inside temperature to be 73*F. Fire extinguisher was last serviced 6//2/2022 and facility conducts rotating monthly safety drills to include fire, active shooter, earthquake, tornado, medical emergency, bomb, violence in the community, and power outage, LPA observed sufficient PPE, paper supplies, sanitizer throughout and any hazardous materials to be locked. Discussed vaccination status of clients/staff, eligibility for boosters and visitation protocols. LPA observed various Covid and other required postings up. Discussed need to udpate Administrator information on record and LPA was provided with copies of many documents. LPA requested updated copies of LIC610E, LIC308 and discussed setting up a Guardian account. There were no deficiencies observed during today's inspection.
Exit interview. Copy of report to be emailed to Administrator.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2022
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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