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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803403
Report Date: 12/15/2021
Date Signed: 12/15/2021 11:46:14 AM

Document Has Been Signed on 12/15/2021 11:46 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:DAYS OUTFACILITY NUMBER:
486803403
ADMINISTRATOR:RICHARD,TROYFACILITY TYPE:
775
ADDRESS:72 MARINA CENTERTELEPHONE:
(707) 592-6546
CITY:SUISUN CITYSTATE: CAZIP CODE:
94585
CAPACITY: 15CENSUS: 3DATE:
12/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Administrator, Troy RichardTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Walters conducted an unannounced Annual Required – 1 yr. Infection Control inspection to this facility and was greeted by staff. Administrator, Troy Richard arrived later. LPA conducted a Risk Assessment with Staff prior to entry. At the time of inspection there were two clients and one staff providing care and supervision. An additional client and staff arrived later. Facility is also offering alternative services for clients who are unable to attend day program in person.

LPA toured the facility with staff and made the following observations:
At the entrance of the facility the facility had a sign-in sheet for visitors, staff and clients. Clients temperatures are checked prior to being transported to the Day Program and logged into binder. Hand sanitizer, disposable mask and gloves were available at the entrance. Signs were posted to promote the spread of COVID1-19. Bathrooms were stocked with hand washing supplies and paper towels. LPA advised that Administrator post hand washing signs, detailing the amount of time, and how to wash signs. Administrator, immediately posted signs in bathrooms.

All clients and staff were wearing mask. Facility is 100% vaccinated. Clients and staff vaccine information are stored in their binders. Facility has submitted their COVID Mitigation Plan and approved on 12/15/21. Facility has more than a 30 day supply of Personal Protective Equipment (PPE) including masks, face shields, incontinence and hand sanitizer. PPE supplies are located in an accessible place for staff. Smoke and carbon monoxide detectors appeared to be operational. Water temperature of faucets used by clients measured at 108.8.

No deficiencies cited during this inspection.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Katrina Walters
LICENSING EVALUATOR SIGNATURE: DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/15/2021
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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