<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347005635
Report Date: 01/22/2025
Date Signed: 01/23/2025 12:52:32 PM

Document Has Been Signed on 01/23/2025 12:52 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/
DIRECTOR:		JULIE AGCAOILIFACILITY TYPE:
775
ADDRESS:8929 EMERALD PARK DRIVETELEPHONE:
(916) 627-1704
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 48CENSUS: 48DATE:
01/22/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Shirley Lewis and Julie AgcaoliTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 1/22/2025, Licensing Program Analyst (LPA) Arvin Villanueva arrived unannounced at this facility to conduct their annual inspection visit. LPA met with Shirley Lewis and Julie Agcaoili and stated the purpose of this visit. Present during this visit, there were 22 clients in care with 11 staff on duty. Facility has submitted an infection control plan.

LPA inspected the physical plant with Shirley and Julie to ensure compliance with Title 22 regulations. LPA observed classrooms, common areas, bathrooms, kitchen area and the office area. Classrooms were observed to have necessary furniture, organized, and free from obstructions of any emergency exits. The exterior plant was observed to be free from debris. A first aid kit was inspected and observed to be complete. Sharps, cleaning supplies and other dangerous items were observed to be locked and inaccessible to participants. The facility temperature thermostat provided a reading of 70*F. Hot water was measured at 114*F. LPA observed multiple fire extinguishers in the hallway and a pull alarm system. Fire extinguishers were last serviced on 10/22/24. Facility conducts drills on a monthly basis and last drill was conducted on 1/8/2025.

LPA reviewed 3 staff files. 3 of 3 staff files were observed to be complete with criminal background clearance, current first aid/CPR certificates, up to date training for 2024. LPA reviewed 3 client files. 3 of 3 client files were observed to have necessary documentation for program and emergency information. Currently, facility currently store medications and provide medication administration assistance to participants. Medications are stored in the Shirley's office. Advisory was provided to Shirley and Julie to obtain PRN Authorization Letter signed by physician for clients taking PRN medications. The facility has an emergency disaster plan and an infection control plan.

{1 of 2}
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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
VISIT DATE: 01/22/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
During the visit, staff were observed interacting with participants and leading class activities. Other participants were out in the community. Participants appeared to be engaged and socializing with peers.

LPA was provided with an updated Liability Insurance Certificate, Surety Bond, Personnel Report, Emergency Disaster Plan, Lease Agreement and Administrative Organization.

Per California Code of Regulations, Title 22, Division 6, Chapter 3, no deficiencies were observed during this visit. An exit interview was held with Shirley and Julie, and a copy of the report was provided.


{2 of 2}
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Arvin Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025
LIC809 (FAS) - (06/04)
Page: 2 of 2