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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005635
Report Date: 10/25/2021
Date Signed: 10/25/2021 12:45:20 PM

Document Has Been Signed on 10/25/2021 12:45 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:VISIONS IN MOTION ADULT DAY PROGRAM, INC.FACILITY NUMBER:
347005635
ADMINISTRATOR:JULIE AGCAOILIFACILITY TYPE:
775
ADDRESS:8915 EMERALD PARK DRIVETELEPHONE:
(916) 627-1704
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 48CENSUS: DATE:
10/25/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:43 AM
MET WITH:Julie AgcaoiliTIME COMPLETED:
12:50 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived at this facility unannounced to conduct an annual inspection visit. LPA Valerio introduced herself, explained the purpose of the visit, and was met by Administrator Julie Agcaoli and Co-Administrator Shirley Lewis. LPA Valerio was screened for COVID-19 symptoms with temperature prior to being allowed inside the facility. Administrators confirmed staff and consumers have not displayed any signs or symptoms of COVID-19 in the last 10 days.
 
The physical plant was toured inside and outside to ensure the safety of the residents and compliance with Title 22 regulations. There were no observed health or safety concerns. LPA conducted the infection control domain tool and discussed the full domain tool with Administrator. The facility has an approved LIC 808 mitigation plan uploaded into FAS. The facility has one central entry point and has implemented screening and sign in procedures at the front of the facility. There is a separate door used for exiting the facility. LPA observed the facility to have COVID-19 informational and hand washing signs posted at the front door and throughout the facility.
 
LPA observed the temperature inside the facility was measured at 70*F, which is within the required range of 68 degrees F and 85 degrees F. The hot water was measured at 111.0*F, which is not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C) as per Title 22 regulations. LPA observed cleaning supplies to be locked and inaccessible to consumers. The facility common areas were clean and furnished with desks and chairs spaced six feet apart. Consumers were engaged in activities with staff during the visit. Desks were clean and had dividers for social distancing. Fire extinguishers was up to date with last check on 10/28/2020.
 
Per California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies were observed during this visit. An exit interview was held, and a copy of the report was given.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE: DATE: 10/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2021
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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