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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001851
Report Date: 10/10/2023
Date Signed: 10/10/2023 10:57:26 AM

Document Has Been Signed on 10/10/2023 10:57 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/GALT I & IIFACILITY NUMBER:
347001851
ADMINISTRATOR:JOE JAQUEZFACILITY TYPE:
775
ADDRESS:1067 C STREET, SUITE 116TELEPHONE:
(916) 685-7666
CITY:GALTSTATE: CAZIP CODE:
95632
CAPACITY: 61CENSUS: 23DATE:
10/10/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Malcolm FowlkesTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to the Day Program. LPA met with Program Site Supervisor Malcolm Fowlkes, and explained the purpose of the visit.

LPA Valerio and Site Supervisor Fowlkes toured the physical plant of the program. LPA observed the common areas to be clean, organized, and free of debris. Sharps, cleaning supplies, and toxins were locked away and inaccessible to the participants. LPA observed a fire pull alarm system and fire extinguishers, which were fully charged with an annual inspection on 05/09/2023. Day Program bathrooms were observed to be clean and fully stocked with paper towels, hand soap, hand sanitizer, and a lidded trash can. Hot water was measured at 113.8*degrees F. Facility temperature was observed to be 74*degrees F.

LPA observed participant files, staff files, and medication files. Participant medication files were observed to be filled out correctly with orders matching. Participant files were current. Staff files were observed to be up to date with required training.

LPA observed staff and participants engaging in multiple activities, including arts and crafts, painting, group work, video games, listening to music, an ISP meeting, and a community outing. Interactions were supportive, positive, and friendly. LPA spoke to multiple participants during the visit.

Per California Code of Regulations (CCR) - Title 22, Division 6, Chapter 3, no deficiencies were observed during today's visit. Site supervisor was in a meeting during the end of the visit and appointed facility staff to sign the report. An exit interview was held facility staff, and a copy of the report was provided.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 10/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2023
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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