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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001851
Report Date: 10/07/2024
Date Signed: 10/07/2024 10:14:37 AM

Document Has Been Signed on 10/07/2024 10:14 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ELK GROVE ADULT COMMUNITY TRAINING/GALT I & IIFACILITY NUMBER:
347001851
ADMINISTRATOR/
DIRECTOR:		JOE JAQUEZFACILITY TYPE:
775
ADDRESS:1067 C STREET, SUITE 116TELEPHONE:
(916) 685-7666
CITY:GALTSTATE: CAZIP CODE:
95632
CAPACITY: 61CENSUS: 44DATE:
10/07/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Malcolm FowlkesTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct an annual required inspection. LPA Valerio met with Program Supervisor Gary and Program Site Manager Malcolm Fowlkes, and explained the purpose of the visit.

LPA Valerio and Staff Malcolm toured the program to ensure compliance with Title 22 regulations. LPA Valerio observed two classrooms. Both classrooms were observed to be clean, organized, and stocked with items for activities. Participants appeared happy, engaged, and supported by staff members. Medications, sharps, and chemicals were observed to locked and inaccessible to participants. Bathrooms were observed to be fully stocked with hygiene products, soap, paper towels, and toilet paper. Hot water was measured to deliver hot water at 115.0 degrees F. LPA observed a fire pull alarm system and fire extinguishers, which were fully charged with an annual inspection on 05/09/2024.

LPA Valerio reviewed 3 participant files and 3 staff files. Participant files were observed to be complete with required documentation. Staff files were observed to have required training.

LPA Valerio requested the following documentation: LIC 500, LIC 308, LIC 610, Copy of Administrator Certificate

Per California Code of Regulations (CCR) - Title 22, Division 6, Chapter 3, no deficiencies were observed during today's visit. 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: 10/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/07/2024
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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