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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005635
Report Date: 01/30/2024
Date Signed: 01/30/2024 12:33:16 PM

Document Has Been Signed on 01/30/2024 12:33 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:VISIONS IN MOTION ADULT DAY PROGRAM, INC.FACILITY NUMBER:
347005635
ADMINISTRATOR:JULIE AGCAOILIFACILITY TYPE:
775
ADDRESS:8929 EMERALD PARK DRIVETELEPHONE:
(916) 627-1704
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 48CENSUS: 47DATE:
01/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Julie Agcaoli and Shirley LewisTIME COMPLETED:
12:45 PM
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On 1/30/2024, at 10:15am, Licensing Program Analyst (LPA) Arvin Villanueva conducted an unannounced annual required visit, with the use of the CARE Inspection Tool. LPA met with the administrator on record, Julie Agcaoili, and explained the purpose of today’s visit. Shirley Lewis, CEO, arrived shortly after. The facility is currently approved to serve 48 ambulatory adults age 18 years old and above. Present during this visit, there were 20 clients in care with 10 staff on duty. Facility has submitted an infection control plan.

At 10:45am, LPA and the administrator toured facility and grounds. No accessible bodies of water or fire safety hazards observed. During the visit, LPA observed day program clients to be participating in a group activity with sufficient amount of staff members present to assist clients. LPA toured the facility inside including but not limited to facility activity rooms, conference room, and kitchen area. LPA observed 2 facility bathrooms to be clean and odor free and equipped with liquid soap and paper towels. Kitchen was observed to be clean and free from flies and pests. Clients belongings were observed to be stored. The facility common areas were clean and furnished. Activities areas are clean and sanitized daily.



Toxins, cleaning supplies, and sharps are observed to be locked and inaccessible to clients in care. Smoke and carbon monoxide detectors were observed as operational. Observed were 4 fire extinguishers were last inspected on 10/2/2023. First aid kit was observed to be complete. Clients in care do not require medications during day program hours. The facility is able to designated and dedicated a COVID-19 isolation area, if needed. LPA observed the temperature inside the facility was measured at 73 degrees F. The hot water was measured at 114 degrees F. Facility staff conducts hot water checks monthly and document measurements.

LPA reviewed five (5) staff records and five (5) client records. All staff are fingerprint cleared and associated to this day program. Additionally, review of staff records shows current first aid and CPR certificates. All clients have required documents for community care licensing (CCL). LPA also reviewed documentation of quarterly fire/evacuation drills. LPA requested copies of the following documents from the administrator: updated liability insurance certicate. Current surety bond and LIC308 was submitted to the Department prior to this visit. Facility administrator updates facility roster through Guardian.

No deficiencies cited per California Code of Regulations, Title 22, Division 6, Chapter 8

An exit interview was conducted with Julie Agcaoili and Shirley Lewis, and copy of report was provided.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2024
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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