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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004234
Report Date: 10/19/2022
Date Signed: 10/19/2022 10:25:25 AM

Document Has Been Signed on 10/19/2022 10:25 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:REACH ADULT DEVELOPMENT SITE #3FACILITY NUMBER:
347004234
ADMINISTRATOR:SUH, SEANFACILITY TYPE:
775
ADDRESS:2204 KAUSEN DR STE 120TELEPHONE:
(916) 539-0588
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 45CENSUS: 0DATE:
10/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Deannedra Cicolani, DirectorTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced Required - 1 Year Inspection Visit at facility. LPA was allowed entry into the building. LPA met with Program Director regarding today's visit. LPA observed no clients at facility, they are in zoom meetings on Wednesdays.

LPA and Director toured and inspected the physical plant inside and outside to ensure all passageways, and other areas of potential hazards are free of obstruction. LPA observed the kitchen area for the ability to prepare food, rest area, and exercise area. Clients bring their own lunches and snacks daily, in addition to when cooking classes are offered food is provided for the participants in that session for that day. If a client needed a lunch on a particular day, the staff would either provide the lunch or contact the care home.

LPA observed, storage cubbies for clients to use in each instruction area, and lighting throughout the facility. The temperature inside the building measured at 72.5*F which is within the required range of 68-85*F. The hot water temperature was measured at 118.4*F which is within the required range of 105-120*F.
The first aid kit included supplies such as sterile first aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide. LPA observed the fire extinguisher(s) which were inspected 6/17/2022, smoke and carbon monoxide detectors. Facility has central heating and air. Fire Drill conducted 10/07/22.

LPA reviewed three (3) resident files and four (4) staff files during this visit. Staff have current First Aid/CPR certificates. LPA explained the new inspection tool process that will occur in the near future for all annual inspections.
Per the California Code of Regulations, Title 22, Division 6, Chapter 6, no violations were observed during this visit. Exit interview held with director and a copy of report given.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Ruth Wallace
LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2022
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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