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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803155
Report Date: 11/27/2023
Date Signed: 11/27/2023 02:00:51 PM

Document Has Been Signed on 11/27/2023 02:00 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, 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: 7DATE:
11/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH: Caregiver, Edith Briones
Licensee, Elfleda Delacruz		TIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced for the purpose of conducting a Required 1 year inspection. LPA was greeted at the door by Caregiver, Edith Briones, and was granted access into the facility. Licensee arrived 1 hour and 15 minutes later.

LPA toured the one story facility which was found to be clean, in good repair, at a comfortable temperature with exits free from obstruction. The facility consists of a kitchen, 2 bathrooms, storage room, a multi purpose room, and two staff offices. Bathrooms contained necessary grab bars. Hot water measured at 110 degrees F which is within Title 22 regulations of 105 to 120 degrees F in faucets used by clients. Participants typically bring their own lunches and snacks unless there is a party or special occasion. Should clients forget their lunch staff will purchase or prepare a lunch for them. All items that could constitute danger were found to be inaccessible at the time of the inspection. Facility does not dispense medication to clients in care. Fire extinguishers were observed to be present with an inspection tag date of July 2023. Smoke Detectors sound directly to the Fire Station. Carbon Dioxide Detector was tested and found to be operational during the inspection. A sample review of 5 client and 5 staff records were conducted. Transportation is paid for by NBRC and vendorized through North Bay Regional Center. Staff and client interviews were conducted. First Aid Kit was inspected and found to be appropriate during the inspection. During the staff record review, LPA observed that 1 out of 5 staff members did not have a valid First Aid/CPR card due to it expiring. The remaining 4 staff members had valid and unexpired First Aid/CPR and were present during today's Required 1 year inspection. Staff member will be getting a new First Aid/CPR Card (See LIC 9102-Technical Violation). Licensee indicated that the training is complete, but licensee cannot find it (See LIC9102- See Technical Violation). Facility is in the process of updating the Infection Control Plan. Licensee was given form LIC 9283 (See LIC 9102-Technical Violation). LPA reviewed the Emergency Disaster Plan and found that document to be appropriate during the inspection. Emergency disaster drill was last conducted in November 6, 2023. (Report continued on LIC 809C)
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE: DATE: 11/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/27/2023
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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: LEARNING WITHOUT LIMITS DAY PROGRAM
FACILITY NUMBER: 486803155
VISIT DATE: 11/27/2023
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LPA requested the following documents:

LIC 500-Personnel Report
LIC 308-Designation of Responsibility
Liability insurance
Control of Property
Client Roster
Staff Roster
Infection Control Plan

No deficiencies were cited during today's Required 1 year inspection. Exit interview was conducted and a copy of this report was given to the Licensee.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE:

DATE: 11/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2023
LIC809 (FAS) - (06/04)
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