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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005030
Report Date: 07/08/2024
Date Signed: 07/08/2024 01:11:23 PM

Document Has Been Signed on 07/08/2024 01:11 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:REACH ADULT DEVELOPMENT SITE #1FACILITY NUMBER:
347005030
ADMINISTRATOR/
DIRECTOR:		SUH, SEANFACILITY TYPE:
775
ADDRESS:4256 FRUITRIDGE RDTELEPHONE:
(916) 838-4130
CITY:SACRAMENTOSTATE: CAZIP CODE:
95820
CAPACITY: 60CENSUS: 30DATE:
07/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:13 AM
MET WITH:Nati MaugaTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
NARRATIVE
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On 07/08/24 at 11:05 AM Licensing Program Analyst (LPA) Pang Lee arrived at Reach Adult Development Site #1 for the purpose of conducting a required 1 year annual inspection. LPA met with Program Director, Nati Mauga and conducted a tour of the facility. The census is 30 with 8 facility staff.

LPA and Program Director evaluated the physical plant to ensure the health and safety of the client in care. Areas inspected are including but not limited to the kitchen, client activity rooms, client bathrooms, storage room, supply closet, computer room, staff break room with a stove, staff office, client quiet room and outdoor areas. LPA observed the facility to be free of odor, clean and in good repair. LPA observed that all rooms are equipped with the required furniture and sufficient lighting throughout the facility. LPA observed locked closets for the storage of cleaning solutions and knives.

LPA measured the water temperature, temperature measured at 114.7 degrees Fahrenheit which meets the 105-120 degree Fahrenheit regulation. Fire extinguishers and smoke detectors are current and in compliance with fire safety. Fire extinguisher was last service on 04/07/2024. The last fire drill was conducted on 07/05/2024. LPA did not observed the facility to have a carbon monoxide detectors. Program Director was also not able to find the carbon monoxide in the facility. First aid kit was checked and is complete. Facility does not currently administer or retain client medications. LPA Lee reviewed 6 out of 6 client files and they were complete. LPA Lee also reviewed 4 facility staff files and they were also complete.

As a result of this annual visit, the facility is not in compliance with Title 22 Regulation, and the deficiency can be found on the LIC 809 D page. An exit interview was conducted, and a copy of these LIC 809 reports, LIC 809-D page, and Appeals rights were provided to the facility.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE: DATE: 07/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/08/2024
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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Document Has Been Signed on 07/08/2024 01:11 PM - It Cannot Be Edited


Created By: Pang Lee On 07/08/2024 at 12:54 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: REACH ADULT DEVELOPMENT SITE #1
FACILITY NUMBER: 347005030

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1503.2
General Provisions
Every facility licensed or certified pursuant to this chapter shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations and interview the licensee did not comply with the section cited above. LPA Lee and Program Director Nati Mauga did not observed the facility to have a carbon monoxide detectors, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/09/2024
Plan of Correction
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LIcensee agrees to purchased a carbon monoxide detector and send via email LPA Lee proof of purchased and install carbon monoxide detector by POC date 07/09/2024 by 5:00 PM end of day. (pang.lee@dss.ca.gov)
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME:Pang Lee
LICENSING EVALUATOR SIGNATURE:
DATE: 07/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/08/2024


LIC809 (FAS) - (06/04)
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