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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004234
Report Date: 08/28/2023
Date Signed: 08/28/2023 12:39:24 PM

Document Has Been Signed on 08/28/2023 12:39 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 AC/SC, 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: DATE:
08/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Deannedra CicolaniTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to conduct an annual inspection. LPA Moleski met with program director Deannedra Cicolani and explained the purpose of the visit.

LPA Moleski reviewed five client files (R1-R5) and five staff files (S1-S5).

LPA Moleski toured the facility with Cicolani and inspected common areas, a kitchen and bathrooms. Furniture and furnishings were sufficient to meet the needs of residents. The facility temperature was 72 degrees Fahrenheit, which is within the required range of 68 and 85 degrees. The facility's water temperature measured 110 degrees Fahrenheit, which is within the required range of 105 and 120 degrees.

LPA Moleski observed first aid supplies, a fully-charged and up-to-date fire extinguisher, and smoke detectors. LPA Moleski observed locked storage containers for the storage of medication. LPA Moleski observed locked storage areas for the storage of cleaning solutions and knives.

LPA Moleski interviewed three staff members (S1, S3, S6) and one client (R7).

No deficiencies were cited during this visit. An exit interview was conducted and a copy of this report was left with Cicolani.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2023
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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