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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002915
Report Date: 09/14/2023
Date Signed: 09/14/2023 10:22:55 AM

Document Has Been Signed on 09/14/2023 10:22 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:RCCA COMMUNITY ACCESS PROGRAMFACILITY NUMBER:
345002915
ADMINISTRATOR:GOMEZ, BRENDAFACILITY TYPE:
775
ADDRESS:4980 WATT AVENUE SUITE C/DTELEPHONE:
(530) 933-1590
CITY:NORTH HIGHLANDSSTATE: CAZIP CODE:
95660
CAPACITY: 43CENSUS: 0DATE:
09/14/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Sharrae Elston, Ashley Thomas, Marie BerminghamTIME COMPLETED:
10:15 AM
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On 09/14/2023, Licensing Program Analyst (LPA) Cassie Yang arrived announced to the facility to complete the Pre-licensing inspection. LPA met with Executive Director Sharrae Elston, staff Marie Bermingham, and Ashley Thomas and explained the purpose of the visit.

During today's inspection, LPA and staff toured the interior and exterior of the facility to ensure the health and safety of clients in care. LPA toured the following rooms of the facility: Media, Exercise, Beauty, Sensory, Art, Game, Quiet and Recreation. LPA observed the toxins such as nail polish remover to be locked in the Beauty Room. LPA observed scissors to be locked in the Art Room. Additionally, LPA observed dining room with six tables, two restrooms for clients use, medication room and a break room which LPA was informed are for staff usage.

LPA observed the Outside Recreation Room to be behind the facility. LPA observed the area to be gated, with presence of shaded table and bench for clients. Additionally, LPA observed outdoor to have basketball, soccer and planting activities.

LPA observed fire extinguisher to be to be last serviced on 07/14/2023. LPA observed the presence of several games and activities available for clients in care.

As a result to today's visit, LPA did not observe any deficiencies.

Comp III has been waived as facility is doing change of location.

Exit interview conducted and a copy of the report was provided.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2023
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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