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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340312462
Report Date: 09/23/2025
Date Signed: 09/23/2025 02:49:11 PM

Document Has Been Signed on 09/23/2025 02:49 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 FUENTEFACILITY TYPE:
775
ADDRESS:8089 MADISON AVE, SUITE 4TELEPHONE:
(916) 962-2766
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY: 60CENSUS: 58DATE:
09/23/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Stephanie Howard, Program Director TIME VISIT/
INSPECTION COMPLETED:
02:50 PM
NARRATIVE
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Licensing Program Analyst (LPA) Sabrina Calzada arrived at the unannounced to conduct a Required 1- Year Inspection and met with Stephanie Howard, newly appointed Program Director. The facility is an Adult Day Program vendorized by the Regional Center and licensed to serve (60) adult/elderly developmentally disabled clients, (15) of whom may be non-ambulatory. LPA observed (28) clients initially present and (8) staff. Around 12:30, (30) clients returned with (7) additional staff. Program hours are 8:30 am- 2:00 pm Mon-Fri. Clients were engaging in various activities throughout the facility.

LPA and the Program Director toured the interior/exterior of the facility and observed it to be clean, safe, odor free and in good repair. There are designated areas for woodworking, a learning corner, fitness, music, cooking, computers, art and free choice, and an isolation room where clients can rest or quarantine. There is a basketball court and picnic table outside in the back. Staff ratio is 4:1. The inside temperature was 72*F. Fire extinguisher was last serviced 7/8/25 and there are monthly safety drills for different types of emergencies. There are sufficient paper supplies, PPE, and sanitizer throughout, eye wash. All toxins and sharps were locked. There is one complete First Aid kit and additional kits are being replenished with new supplies. Clients bring their own lunches and food/snacks are served occasionally. Hot water temperature measured 119*F in a bathroom. Personal Rights and Emergency Disaster information is posted in the common area. LPA reviewed (4) staff and (4) client records. Files were complete with required information. All staff is cleared/associated, has current First Aid/CPR certifications, and completed on-line training.

Per California Code of Regulations, Title 22, the following (2) deficiencies are being cited today.
Exit interview. Copy of report and appeal rights provided.
NAME OF LICENSING PROGRAM MANAGER: Maribeth Senty
NAME OF LICENSING PROGRAM ANALYST: Sabrina Calzada
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/23/2025
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 4
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 09/23/2025 02:49 PM - It Cannot Be Edited


Created By: Sabrina Calzada On 09/23/2025 at 02:07 PM
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: ACE-IT II
FACILITY NUMBER: 340312462

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/23/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82075(b)(1)(A)
82075 Health-Related Services
(b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications.
(1) Program staff who receive training from a licensed professional, may assist clients with metered-dose inhalers, and dry powder inhalers if the following requirements are met:
(A) The licensee obtains written documentation from the licensed professional, outlining the procedures and the names of program staff whom they have trained in those procedures.
(B) The licensee ensures that the licensed professional, reviews staff performance as necessary, but at least annually.
(C) All staff training shall be documented in the facility personnel files.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interviews and record review, the licensee did not comply with the section cited above in (3) out of (3) staff who provided medication administration, including an inhaler, to clients (C1, C2) in September, 2025,i which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/24/2025
Plan of Correction
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Licensee/Administrator agree to schedule training for all staff who administer medications. The training must be given by an medical professional such as a Licensed Vocational Nurse (LVN). Documentation of training to be provided by October 8, 2025.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Maribeth Senty
NAME OF LICENSING PROGRAM MANAGER:
Sabrina Calzada
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2025


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 09/23/2025 02:49 PM - It Cannot Be Edited


Created By: Sabrina Calzada On 09/23/2025 at 02:23 PM
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: ACE-IT II
FACILITY NUMBER: 340312462

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/23/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82036
82036 Licensing Fees

(a) An applicant or a licensee shall be charged fees as specified in Health and Safety Code Section 1523.1.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in more than one year's annual fees, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/23/2025
Plan of Correction
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All past due annual fees and the current annual fee (due 10/5/25) were paid on 10/3/25. The Program Director will calendar when next year's annual fees are due to avoid any late fees.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Maribeth Senty
NAME OF LICENSING PROGRAM MANAGER:
Sabrina Calzada
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2025


LIC809 (FAS) - (06/04)
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