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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405801621
Report Date: 01/09/2025
Date Signed: 01/09/2025 01:44:40 PM

Document Has Been Signed on 01/09/2025 01:44 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:NCI AFFILIATES, INC-LINNEFACILITY NUMBER:
405801621
ADMINISTRATOR/
DIRECTOR:
TRACI M HOLLINGERFACILITY TYPE:
775
ADDRESS:496 LINNE ROADTELEPHONE:
(805) 238-6630
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 75CENSUS: 25DATE:
01/09/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:10 AM
MET WITH: Administrator Traci Hollineger TIME VISIT/
INSPECTION COMPLETED:
01:44 PM
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At 10:15am on 01/09/2025, Licensing Program Analyst (LPA) Jeffries arrived to the facility unannounced to conduct the annual facility inspection. LPA met with Program Coordinator, Lote Rouse (PC), announced who he is and the reason for the visit. Administrator Traci Hollineger also joined the annual inspection during the control tools module review.

PC and LPA conducted a physical tour of the facility and facility grounds. This facility has a main lobby, conference room, nine classrooms, kitchen, two storage rooms and two bathrooms. Medications are locked in a cabinet or drawer in the kitchen toward the back of the facility kitchen at current time of inspection there are no clients serviced that require medications. Lunches are brought from home by the clients and assisted as need by staff as needed. There is a supply of food and snacks on hand for clients who did not come to the program with lunch. LPA noted that all classrooms were clean and free of hazards and no obstructions to exits. City of Paso Robles Fire Department conducted the annual fire inspection for the facility on 01/06/2025. LPA noted that there is an Administration office attached to the facility on the north side of the facility and occupational program on the south side of the facility, both administration and occupational program have inside access to the facility. LAP did not note any visible violations on the cursory tour and no citations were issued on the annual physical tour of the facility.

Administrator, PC, and LPA conducted a full review of the annual care tools modules. LPA noted that there were no technical, violations, or citations noted during the full review of the annual care tools module. LPA noted that no technical, violations, or citations were issued during this annual facility inspection.

Exit interview, report read, and report provided.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2025
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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