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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803155
Report Date: 02/02/2022
Date Signed: 02/02/2022 11:45:28 AM

Document Has Been Signed on 02/02/2022 11:45 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:LEARNING WITHOUT LIMITS DAY PROGRAMFACILITY NUMBER:
486803155
ADMINISTRATOR:DELACRUZ, ELFLEDAFACILITY TYPE:
775
ADDRESS:244 TRAVIS COURTTELEPHONE:
(707) 759-4579
CITY:SUISUNSTATE: CAZIP CODE:
94585
CAPACITY: 45CENSUS: 0DATE:
02/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Licensee, Elfleda DelacruzTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Katrina Walters conducted an unannounced 1 year required inspection and met with Administrator/Licensee, Elfleda Delacruz. The inspection is focused on the Infection Control procedures and practices of this facility. This facility has sent their mitigation plan, and it has been approved by Community Care Licensing. There were no clients present during inspection. All staff were wearing mask. Facility is offering alternative services.

Signs were posted on all exterior doors, encouraging the use of mask and to not enter if the visitor is showing symptoms. At there entrance, there is a check in section for visitors, clients and staff. The desk is supplied with personal protective equipment, and temperature thermometer. LPA observed a sign in sheet that staff have signed and recorded their temperature.

LPA reviewed client and staff records with Administrator. Clients and Staff vaccination records were stored in all the binders. All staff have received their vaccine. Staff have received training on infection control and Personal Protective Equipment, which was documented in staff training binders. Clients who were able to go to their doctors have had their Physician's and Emergency Contact updated. LPA then toured the facility with Administrator and observed that the facility was clean and a comfortable temperature. Facility is cleaned after usage and disinfected weekly using disinfectant misters. Bathrooms were stocked with paper towel and hand soap. Hand washing signs were posted at all sinks used by clients and staff. Facility had a 30 day supply of incontinence, personal protective equipment. Desk in the activity area were physically distanced, and had plexi screens to protect against droplet precautions. Staff were conducting activities with clients by zoom. There were no citations issued during today's visit. Exit interview conducted with Administrator.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Katrina Walters
LICENSING EVALUATOR SIGNATURE: DATE: 02/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/02/2022
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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