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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803403
Report Date: 10/17/2023
Date Signed: 10/17/2023 11:29:39 AM

Document Has Been Signed on 10/17/2023 11:29 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:DAYS OUTFACILITY NUMBER:
486803403
ADMINISTRATOR:RICHARD,TROYFACILITY TYPE:
775
ADDRESS:72 MARINA CENTERTELEPHONE:
(707) 592-6546
CITY:SUISUN CITYSTATE: CAZIP CODE:
94585
CAPACITY: 15CENSUS: 12DATE:
10/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator, Troy RichardTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Days Out for the purpose of conducting a Required 1 year inspection. LPA met with Director, Troy Richard, and was granted access into the facility.

LPA and Director toured the 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, 2 class rooms, a quiet area, an outdoor patio, and a staff office. Bathrooms contained necessary grab bars, hygiene products and continence care products available for for client use. 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. Fire extinguishers were observed to be present with an inspection tag date of May 2023. Smoke Detectors and Carbon Monoxide Detectors were tested and found to be operational during the inspection. A sample review of 5 client and 5 staff records was conducted. Vehicle inspection and maintenance logs are maintained and were observed to be kept on a daily basis for all vehicles transporting clients. A sample review of 5 staff records were reviewed and determined that additional staff training is required for staff members (See LIC 9102-Technical Violation) Staff and client interviews were conducted. First Aid Kit was inspected and found to be appropriate during the inspection. First Aid/CPR Cards were active for all staff members with the exception of one (See LIC 9102-Technical Violation).

LPA advised facility to contact County Public Health and Community Care Licensing immediately if symptoms or COVID-19 + or any other infectious diseases in the facility. Licensee shared that the Infection Control Plan will need to be updated before being reviewed (See LIC 9102-Technical Advisory). (Report continued on LIC 809C).
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2023
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: DAYS OUT
FACILITY NUMBER: 486803403
VISIT DATE: 10/17/2023
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LPA requested the Director to send the Infection Control Plan once it is completed. LPA discussed the Emergency Disaster Plan with the Director. Emergency disaster drill was last conducted in January 2023 with the expected next drill to be conducted today, October 17, 2023 (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
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 Director.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023
LIC809 (FAS) - (06/04)
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