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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340312462
Report Date: 10/11/2024
Date Signed: 10/11/2024 02:56:52 PM

Document Has Been Signed on 10/11/2024 02:56 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/
DIRECTOR:
LACY DE LA PUENTEFACILITY TYPE:
775
ADDRESS:8089 MADISON AVE, SUITE 4TELEPHONE:
(916) 962-2766
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 60CENSUS: 55DATE:
10/11/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Lacy de la Fuente, Administrator TIME VISIT/
INSPECTION COMPLETED:
03:00 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 Lacy de la Fuente, Administrator, and explained the reason for the inspection. 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 (55) clients to be present and (16) additional staff present. Program hours are 8:30 am- 2:00 pm Mon-Fri. Clients were engaging in various activities throughout the facility.

LPA and Administrator 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. Doors are locked from the outside. Staff ratio is 4:1. LPA observed the inside temperature to be 73*F. Fire extinguisher was last serviced 8/5/24 and facility conducts monthly safety drills for different types of emergencies. There are sufficient paper supplies, PPE, and sanitizer throughout, eye wash, and any toxic and sharps to be locked. There are multiple complete First Aid kits on site. Clients bring their own lunches and food/snacks are served occasionally. There is a cooler that dispenses cold and hot water. Clients participate in community outings, including shopping and attending/participating at the farmer's market. Hot water temperature measured 114*F in the kitchen sink where clients have access.

Staff and client files are all electronic. LPA reviewed (5) client records and found them to be complete with Admission Agreement, physician's reports and current care plan/IPP. (6) staff binders were reviewed- all staff is cleared/associated, has current First Aid/CPR certifications, and completed on-line training, which is monitored monthly. LPA requested an updated copy of LIC308.
There were no deficiencies observed during today's inspection. There is a Technical Advisory Note being issued. Exit interview. Copy of report provided.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2024
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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