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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803406
Report Date: 09/16/2021
Date Signed: 09/16/2021 11:15:53 AM

Document Has Been Signed on 09/16/2021 11:15 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:PACE PARKWAYFACILITY NUMBER:
486803406
ADMINISTRATOR:AMBER ANDERSFACILITY TYPE:
775
ADDRESS:950 MASON STTELEPHONE:
(707) 447-3767
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY: 75CENSUS: 60DATE:
09/16/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Stephanie Garland, AdministratorTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Lopez arrived unannounced to conduct an Required-1 year inspection and met with Stephanie Garland, Administrator. The annual inspection is focused on the Infection Control procedures and practices of this Adult Day Program.

The facility is currently providing some in-person Day Program services for 36 clients. All other clients attend program virtually. Fire Extinguishers were found to be last charged on September 15, 2021.

Upon arrival, LPA observed a screening station at front entrance and a sign-in sheet. Staff took LPA temperature when LPA arrived. Sign-in sheet had a section for visitors to document name and answer COVID-19 screening questionnaire. Staff are screened for COVID-19 (including temperature check) upon arrival to the facility and are also logged into a sign-in sheet. LPA conducted a walk-through of the facility with Administrator and observed COVID-19 precaution postings. LPA advised Administrator to post more signs in Day Program hallway. Staff clean the facility twice daily and high touched surfaces are disinfected multiple times a day. Clients bring their own lunch to Day Program. During lunch, staff bring lunch to clients while in their classrooms. Classrooms are limited to the number of clients depending on the size of classroom. LPA observed clients to be social distancing at the time of visit.

Facility staff have completed training on PPE use and infection prevention. The facility has a supply of PPE. Staff wore masks during today's visit. The facility has a COVID-19 Mitigation Plan Report on Epidemic Outbreaks specific to COVID-19 .

Exit interview conducted with Stephanie Garland, whose signature on this document confirms receipt.

No deficiencies cited during today's inspection.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Karen Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 09/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2021
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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