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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405800227
Report Date: 06/20/2024
Date Signed: 06/20/2024 11:48:45 AM

Document Has Been Signed on 06/20/2024 11:48 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:CLIENT CENTERED TRAINING AND SERVICESFACILITY NUMBER:
405800227
ADMINISTRATOR/
DIRECTOR:
TRACY BOOKERFACILITY TYPE:
775
ADDRESS:879 MEINECKE STTELEPHONE:
(805) 544-5332
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93405
CAPACITY: 33CENSUS: 20DATE:
06/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:07 AM
MET WITH:Administrator - Tracy Booker TIME VISIT/
INSPECTION COMPLETED:
11:58 AM
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At 8:00am on 06/20/2024, Licensing Program Analyst (LPA) Jeffries arrived at the facility unannounced to conduct annual inspection. LPA met with Administrator Tracy Booker and announced the reason for the visit being the facilities annual inspection.
This Day Program is attached to an Intermediate Care Facility for Developmental Disable (ICFDD) [Casa De Vita] licensed by the California Department of Public Health. There is a single entry point with a lobby where a self screening and check in binder for visitors log-ins' and employees log-ins in the front from the parking lot. In order to access the day program, one must enter the ICFDD walk down two halls from the lobby to access the Day Program. LPA noted that Casa De Vita occupies the majority of the facilities building and is only separated by an open hallway and a floor guard to signify where the Day program facilities begin. The facility has four classrooms on one wing. The main wing has two client restrooms and a changing room. There is a staff room and staff restroom that is locked at all times and accesses with a key, There is a large outside area with ample shade and seating. There is an additional free standing outside classroom with additional bathroom that is accessed from the outside area.
Administrator and LPA conducted a full review of the annual care tools modules with no citations. The Administrator and LPA, conducted a physical tour of the areas of the facility that is licensed as the Day Program. Daily PPE supplies are located in the classroom in the main Day Program area and a closet in the autonomous classroom. There is additional PPE in ample supply located in the ICFDD area of the facility for Day Program use. LPA noted that lunches are placed in the refrigerator in the staff room. LPA noted that no medications are administered through the Day Program, Casa De Vita administers all medication for the Day Program Clients. LPA observed report from Alpha fire indicating that the sprinkler system was pressured tested on 03/01/2024. LPA did not observe any visible hazards or deficiencies during the tour with Administrator. LPA noted no citations, violations were assessed during this annual inspection.
LPA noted that staff and client interviews were conducted 6 of 6 staff and 3 of 20 clients,, however no forms were produced due to computer malfunction.
Exit interview, report read, and report provided.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2024
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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