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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340312462
Report Date: 10/03/2023
Date Signed: 10/03/2023 01:26:56 PM

Document Has Been Signed on 10/03/2023 01:26 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:ACE-IT IIFACILITY NUMBER:
340312462
ADMINISTRATOR:LACY DE LA PUENTEFACILITY TYPE:
775
ADDRESS:8089 MADISON AVE, SUITE 4TELEPHONE:
(916) 962-2766
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 60CENSUS: 31DATE:
10/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Stephanie Howard, Asst Program Director TIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived at the facility unannounced on 10/3/2023 to conduct a Required 1- Year Inspection. LPA met with Stephanie Howard, Assistant Program Director, and explained the reason for the inspection. LPA spoke to Administrator, Lacy De La Fuente, by phone, who indicated she was tele-working today. 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 (31) clients to be present and (10) additional staff present. Program hours are 8:30 am- 2:00 pm Mon-Fri.

LPA 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. There is an isolation room where clients can rest or quarantine. There is a basketball court and picnic table outside in the back of the building. Staff ratio is 4:1. LPA observed the inside temperature to be 73*F. Fire extinguisher was last serviced 8/16/23 and facility conducts monthly safety drills for different emergencies. LPA observed sufficient paper supplies, PPE, and sanitizer throughout, eye wash, and any toxic and sharps to be locked. There is a complete First Aid kit on site. Clients bring their own lunches and food/snacks are served for holiday celebrations. The program will provide bottled water to clients. Clients participate in community outings, including shopping and farmer's market. Hot water temperature measured 110*F in a client bathroom. Visitors are regularly screened for temperature and asked if showing signs/symptoms of being ill. The Emergency Disaster Plan and Infection Control Plans were reviewed and found to be complete. LPA provided a blank copy of LIC9282 for reference. Department Provider Information Notices (PIN's) are kept organized in a binder for easy reference.

LPA reviewed (3) client binders and found them to be organized and contain current paperwork. LPA reviewed all staff binders and observed current First Aid/CPR certifications for all staff as well as completion of required and additional training topics. LPA requested an updated copy of LIC308. There were no deficiencies observed during today's inspection.
Exit interview. Copy of report provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2023
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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