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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005635
Report Date: 01/25/2022
Date Signed: 01/25/2022 12:50:51 PM

Document Has Been Signed on 01/25/2022 12:50 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: 16DATE:
01/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Julie AgcaoliTIME COMPLETED:
01:10 PM
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Licensing Program Analyst (LPA) Christina Valerio arrived at the facility unannounced to conduct the annual inspection. LPA Valerio confirmed with staff that there are zero participants or staff at the program that have experienced any signs or symptoms of COVID-19 in the last 10 days. LPA Valerio was screened for COVID symptoms prior to being allowed entry.

LPA and staff toured the facility to ensure compliance with Title 22 regulations. LPA observed the hot water to be at 119.0*F. The temperature inside the facility was 72*F, which is within compliance. The facility had plastic dividers at each table, had tables spaced well over 6 feet distance, and items were organized in all areas. Common area were clean and had hand sanitizer for use. No emergency exits were obstructed. LPA also conducted the infection control tool.

LPA Valerio was later met by Administrator Julie. Administrator and LPA discussed COVID related PINs, vaccination status of employees and participants, booster requirements, and reviewed facility documentation. Administrator gave LPA updated emergency plan documentation.

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: 01/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/25/2022
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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