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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342790074
Report Date: 09/13/2022
Date Signed: 09/13/2022 10:28:21 AM

Document Has Been Signed on 09/13/2022 10:28 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:COMPREHENSIVE SKILLS TRAINING CENTER, LLC.FACILITY NUMBER:
342790074
ADMINISTRATOR:SAMSON, JASMIN PFACILITY TYPE:
775
ADDRESS:6520 44TH STREET, STE. 306TELEPHONE:
(916) 391-9100
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY: 50CENSUS: 30DATE:
09/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Jasmin SamsonTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Christina Valerio arrived at the facility unannounced to conduct the annual inspection. LPA Valerio confirmed with staff that there are zero participants or staff at the program that have experienced any signs or symptoms of COVID-19 in the last 10 days.

LPA and staff toured the facility to ensure compliance with Title 22 regulations. LPA observed the hot water to be at 110.5*F. The temperature inside the facility was 74*F. The facility had tables spaced well over 6 feet distance with items organized in all areas. Common area were clean and had hand sanitizer for use. No emergency exits were obstructed. LPA conducted the infection control tool. The facility has a space designated for consumers that display symptoms while in program, which can also be used as a meeting room. The program has a front entrance where staff, consumers, and visitors can be screened for COVID-19 symptoms. LPA observed staff engaging in activities with consumers throughout the tour.

LPA obtained the following documents: LIC 500, Emergency Disaster Plan, LIC 308, and administrator certificate

Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. An exit interview was held with Administrator Jasmin Samson, and a copy of the report was given.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2022
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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