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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001442
Report Date: 02/13/2023
Date Signed: 02/13/2023 11:25:10 AM

Document Has Been Signed on 02/13/2023 11:25 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: 51DATE:
02/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Augusta Osayande - Program DirectorTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced Required 1 Year Annual Inspection visit. LPA met with the Program Director and explained the purpose of the visit.

LPA Wallace and program director inspected all four (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 ninety (90) capacity with a current census of fifty one (51). 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 114.8*F in the bathroom and room temperature reads 73*F. Clients 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 extinguishers were inspected 5/20/2022.

Per California Code of Regulations, Title 22, no deficiencies were observed during this visit.

Exit interview was held and a report was given to program director

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Ruth Wallace
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2023
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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