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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001442
Report Date: 02/22/2022
Date Signed: 02/22/2022 10:44:12 AM

Document Has Been Signed on 02/22/2022 10:44 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:ELK GROVE ADULT COMMUNITY TRAINING,INC. ACT IIFACILITY NUMBER:
347001442
ADMINISTRATOR:JAQUEZ, JOEFACILITY TYPE:
775
ADDRESS:9510 ELK GROVE FLORIN RD.,#CTELEPHONE:
(916) 685-7666
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 90CENSUS: 63DATE:
02/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Morgan OttoTIME COMPLETED:
10:50 AM
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On 2/22/22 at 9:35 am, Licensing Program Analyst (LPA) Michael Bilger arrived at this facility unannounced to conduct an annual inspection visit. LPA met with the Site Coordinator Morgan Otto and explained the purpose of the visit.

LPA Bilger inspected all 4 classroom pods which included the following areas: Kitchen, TV rooms, client bathrooms, and outside yard area of the facility to ensure compliance with Title 22 regulations. Facility has a 90 bed capacity with a current census of 63. Facility is an adult day program with client age ranges from 22-87. Services are currently conducted in-person and remote. LPA also conducted the infection control domain tool.
The facility submitted a LIC 808 mitigation plan. The facility also has central entry point and has implemented screening and sign in procedures at the front door area. The facility conducts routine symptom screening for employees, clients, and visitors. LPA observed the facility to have hand washing, COVID - 19 informational, and social distancing signs posted throughout the facility, and on the outside prior to entry. The facility has a designated infection control lead. The facility is able to designate and dedicated a Covid-19 room/bathroom if needed. Common touch surfaces are cleaned after each use.

Water temperature reads 109.4*F in the bathroom and room temperature reads 70*F. Resident classrooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguisher was checked 3/20/2021.

Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview was held with Morgan Otto and a report was given to Morgan
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2022
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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