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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002731
Report Date: 07/22/2024
Date Signed: 07/22/2024 12:21:50 PM

Document Has Been Signed on 07/22/2024 12:21 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:IPS- VINSON DRIVEFACILITY NUMBER:
455002731
ADMINISTRATOR/
DIRECTOR:		KNIGHT, JOSHUAFACILITY TYPE:
735
ADDRESS:1786 VINSON DRIVETELEPHONE:
(530) 605-3755
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY: 4CENSUS: 4DATE:
07/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Administrator, Laura OlsonTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On July 22, 2024 at approximately 10:00 AM, Licensing Program Analyst (LPA), Farhaan Sarangi arrived announced at IPS-Vinson Drive for the purpose of conducting a Required 1 year inspection. LPA was greeted at the door by Administrator, Laura Olson and was granted access into the facility. Clients were at their respective Day Programs and could not be interviewed.

LPA and the Administrator toured the facility. LPA observed the facility to be clean, safe and sanitary with all exits free from obstruction. LPA also observed auditory devices on doorways leading to the outside of the facility. Fire Extinguishers was last inspected on May 2024. All smoke detectors and carbon monoxide detectors were tested and found to be operational at the time of the Pre-Licensing inspection. Hot water temperature measured at 107 degrees in 2 of 2 clients bathrooms. Hot water temperature is within acceptable range of 105-120 degrees. LPA observed sufficient perishable and non-perishable foods located in the fridge. Food menu was observed and found to be appropriate during the inspection. There was ample space for personal hygiene products, bedding and linens, utensils, dishes, and cook ware. Client records, personnel Records, medication were locked in separate cabinets, toxins are kept locked and inaccessible to clients in care. Facility has a first aid kit which was inspected and found to be appropriate during the inspection. There is an outdoor space for activities with a shaded area. During the Required 1 year inspection, LPA advised facility to contact County Public Health and Community Care Licensing immediately if symptoms of COVID-19 + or any infectious diseases in the facility. Infection Control Plan is currently being updated (See LIC 9102-Technical Advisory). Emergency Disaster Plan was reviewed. Emergency Disaster Drills are conducted monthly with the last one occurring in June 2024.

During the Required 1 year inspection, LPAs reviewed 3 of 3 staff files and found those files to be appropriate during the inspection. LPA reviewed 4 of 4 client files and found those to be appropriate during the inspection. LPAs reviewed the Medication Orders and found those to be appropriate during the inspection. First aid certificates were reviewed. (Report continued on LIC 809C)
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE: DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2024
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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: IPS- VINSON DRIVE
FACILITY NUMBER: 455002731
VISIT DATE: 07/22/2024
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LPA found that 1 out of 3 staff members did not have First Aid/CPR Card retained in the file. Administrator disclosed that it was paid for and the staff member might have it. (See LIC 9102-Technical Violation)

LPA requested the following documents:

LIC 500-Personnel Report
LIC 308-Designation of Responsibility
LIC 400- Affidavit regarding Client Cash Resources
Liability insurance
Control of Property
Client Roster
Infection Control Plan

No deficiencies were cited during the Required 1 year inspection. Exit interview was conducted and a copy of this report was emailed to the Administrator.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2024
LIC809 (FAS) - (06/04)
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