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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390317185
Report Date: 03/07/2024
Date Signed: 03/12/2024 10:26:17 AM

Document Has Been Signed on 03/12/2024 10:26 AM - 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:UNITED CEREBRAL PALSY OF SAN JOAQUIN CO.FACILITY NUMBER:
390317185
ADMINISTRATOR:CORINNE FIELDERFACILITY TYPE:
775
ADDRESS:134 PACIFIC ROADTELEPHONE:
(209) 239-3066
CITY:MANTECASTATE: CAZIP CODE:
95337
CAPACITY: 40CENSUS: 25DATE:
03/07/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Melissa ArreolaTIME COMPLETED:
03:30 PM
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Unannounced annual visit made out to this day program on 03/06/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Assistant Program Administrator, Melissa Arreola Rocha, who was briefly interviewed.
Current census was 25 clients.
This day program was currently vendorized through Valley Mountain Regional Center. It was learned that this day program maintained an 3:1 ratio for clients to staff at all times.
Tour of this day program was conducted. It was observed that several classroom units were present and utilized at this time.
All rooms designated as classrooms, activity areas, and common areas for client use were toured. Furniture and furnishings were observed to be present and sufficient to meet the needs of the clients at this time.
Office rooms and other areas intended for client use were toured.
A review of the day program restrooms was conducted.
Hot water temperatures were taken to make sure that the hot water being dispensed was within the allowed range of 105-120 degrees at this time.
Fire extinguishers, placed throughout this day program, were observed to have been annually inspected on 06/26/2023 by the local fire extinguisher company, Butch Young Fire Equipment, and in compliance at this time.
Kitchen area was toured in the back part of this day program.
The use of microwaves and a toaster oven were observed as methods that were used to heat and warm up the food for the clients if necessary. Stove and burners were also present for cooking classes with staff supervision at all times.
Storage area for chemicals and cleaning supplies was observed to be locked and made inaccessible to the clients at this time.
Exterior grounds of this day program were toured.
Perimeter fence and gates were observed to be functional and in good repair at this time.
Entrances and exits used were observed to be supplied with hand sanitizer and masks at this time.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2024
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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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: UNITED CEREBRAL PALSY OF SAN JOAQUIN CO.
FACILITY NUMBER: 390317185
VISIT DATE: 03/07/2024
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A review of (5) day program client files was conducted and noted on the following LIC 858.
A review of (5) day program staff files was conducted and noted on the following LIC 859.

The following forms and documents were requested by this LPA to be updated and submitted into CCL:
  • LIC 308

  • LIC 400

  • LIC 500

  • LIC 610

There were no deficiencies observed or cited during today's annual visit.

Exit Interview
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024
LIC809 (FAS) - (06/04)
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