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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803403
Report Date: 10/19/2022
Date Signed: 10/19/2022 01:08:09 PM

Document Has Been Signed on 10/19/2022 01:08 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:DAYS OUTFACILITY NUMBER:
486803403
ADMINISTRATOR:RICHARD,TROYFACILITY TYPE:
775
ADDRESS:72 MARINA CENTERTELEPHONE:
(707) 592-6546
CITY:SUISUN CITYSTATE: CAZIP CODE:
94585
CAPACITY: 15CENSUS: 5DATE:
10/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:39 AM
MET WITH:Troy SkillmanTIME COMPLETED:
01:17 PM
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Licensing Program Analyst (LPA) Katrina Walters arrived unannounced to conduct a Annual Required - 1 Year inspection and met with Administrator, Troy Skillman. DSP staff was also present during today's visit. The annual inspection is focused on the Infection Control procedures and practices of this Adult Day Program Facility.

The day program is held in a large activity room. There are also dedicated bathroom for clients, staff office, kitchen, quiet room and storage area for program use. Day program clients were socially distanced at their own tables and engaged in activities. Day program clients have a variety of social interaction, games, and activities. Clients lunches are stored in the kitchen, and provided to clients during lunch time. LPA observed that both the bathroom and kitchen were sanitary and in good repair. There was hand soap and paper towels for clients use. All exits were unobstructed. Facility has a COVID-19 screening station (visitor sign-in sheet, COVID questionnaire, thermometer, hand sanitizer). Fire extinguisher was charged and serviced 03/16/2022. smoke and carbon monoxide detector appeared to be operational. The facility has an ample supply of PPE including gloves, hand sanitizer, N-95 respirators, gowns, face shields, and surgical masks. Staff and client's temperatures are taken daily and documented prior to arriving at the facility.

LPA reviewed 3 staff records with Administrator. All staff records were completed with: first aid, CPR training, and vaccination records. The facility has submitted their Infection Control Plan to the California Department of Social Services, Community Care Licensing. Staff have received refresher training on Proper Utilization of PPE, Infection Prevention & Control to Prevent COVID-19. All staff wore face masks during this visit.

Exit interview conducted with Administrator, whose signature on this document confirms receipt.
**No deficiencies cited during this inspection
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Katrina Walters
LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2022
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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