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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001442
Report Date: 02/20/2025
Date Signed: 02/28/2025 02:13:43 PM

Document Has Been Signed on 02/28/2025 02:13 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ELK GROVE ADULT COMMUNITY TRAINING,INC. ACT IIFACILITY NUMBER:
347001442
ADMINISTRATOR/
DIRECTOR:		JAQUEZ, JOEFACILITY TYPE:
775
ADDRESS:9510 ELK GROVE FLORIN RD.,#CTELEPHONE:
(916) 685-7666
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 90CENSUS: DATE:
02/20/2025
TYPE OF VISIT:Case Management - Legal/Non-complianceANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Joe Jaquez, Rebecca Brubaker, and Augusta OsayandeTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Community Care Licensing (CCL) held a Non-Compliance Meeting today via Microsoft Teams on 2/20/25 at 2:00pm to discuss compliance to regulations. The attendees of the meeting were: Regional Manager (RM) Stephenie Doub, Licensing Program Manager (LPM) Stephen Richardson, Licensing Program Analyst(s) (LPA) Victoria Brown, Noel Wolf Peterson, Christina Valerio, Representatives for Elk Grove Adult Community Training, Inc & Elk Grove Community Training: Executive Director Joe Jaquez,, Program Consultant Rebecca Brubaker, and Program Director Augusta Osayande, and Regional Center Community Services Specialist Tom Kasper. RM began the meeting by stating the purpose of the meeting and introductions began.

Subject areas discussed:
    -Collaboration
    -Previous Citations
    -Recording meetings
    -Reporting Requirements
    -Staffing Training
    -Personnel Records
    -Inspection Authority
    -Annual Documents to be updated
    -Mandated Reporters (Staff)
    -Allow for 2 staff to be present during licensing visits
CCL expectations:
    -Facility shall continue to provide a collaborative, respectful environment
    -Facility shall provide in-service training to staff to be documented in their files, reminder to staff that access to personnel information to include address and phone numbers as CCL may contact them outside of business hours for investigation purposes
Continues on LIC 809 - C...
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ELK GROVE ADULT COMMUNITY TRAINING,INC. ACT II
FACILITY NUMBER: 347001442
VISIT DATE: 02/20/2025
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Continued from LIC 809

CCL expectations continued:
    -Facility shall submit requested documents by 2/27/25
    • LIC200 for each facility
    • LIC309 for each facility
    • LIC500 for each facility
    • Staff schedule for each facility
    • Lease Agreement for each facility
    • Letter from Board designating Executive Director with Meeting minutes for each facility
    • Updated Board Organization to include all current members
    • Job Descriptions for all staff positions
    • Update Plan of Operation to include banking institution use for clients

Facility Agreed:
    -To all of the aforementioned
    -They will also have 2 staff present during Licensing visits.

At this time, quarterly visits will be implemented.

Per the California Code of Regulations, Title 22, Division 6, Chapter 6, no deficiencies cited. An exit interview was held.

Executive Director agreed to CCL reviewing the contents of this report via phone and to a copy of this report being provided via email and an electronic email read receipt confirms receiving these documents. In addition, the Executive Director agreed to sign and return the report to LPA Victoria Brown and LPM Stephen Richardson.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
LIC809 (FAS) - (06/04)
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