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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405801854
Report Date: 12/19/2022
Date Signed: 12/20/2022 07:48:24 AM

Document Has Been Signed on 12/20/2022 07:48 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:CAPSLO ADULT DAY CENTERFACILITY NUMBER:
405801854
ADMINISTRATOR:MARA WHITTENFACILITY TYPE:
775
ADDRESS:1345 OAK STREETTELEPHONE:
(805) 239-5679
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 25CENSUS: 7DATE:
12/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:36 AM
MET WITH:Lydia Hunt / Site Supervisor TIME COMPLETED:
02:00 PM
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 At 11:15am on 12/19/2022, Licensing Program Analyst (LPA) Jeffries arrived unannounced to the facility to conduct the annual, infection control inspection. LPA met with Site Supervisor Lydia Hunt (S1) and announced who he was and the reason for the visit. LPA was notified by Administrator Mara Whitten was on vacation.

This Day Program has 4 group rooms, a kitchen and dining room area, two bathrooms and two offices, and a small outside area with table and shade from clients use. Medications are located in the main office in a file drawer in a locked box in the filing cabinet. LPA observed three working fire extinguishers throughout the facility, all passage ways and exits were free from obstructions and working carbon monoxide detector in the dining room area. LPA noted that the facility temperature was an ambient 73*f as it was 39*f outside when LPA arrive for the inspection. LPA noted that facility has a food supply on site in the kitchen and prepares lunch for the clients in program. LPA observed that all bathrooms are stocked with liquid soap and paper towels. LPA note that the facility has more than 30 day supply of PPE on hand. LPA noted that the side door with ramp is used as the single entry screening point for entrance to the facility, and LPA was properly screened upon entrance to the facility,

S1 and LPA conducted the infection control module of the annual inspection. LPA noted that there were no violations or citations noted on the infection control module of the annual inspection. There were no violations or citations issued on this annual infection control inspection.

Exit interview, report signed, and report emailed.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2022
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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