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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803406
Report Date: 10/04/2023
Date Signed: 10/04/2023 11:33:27 AM

Document Has Been Signed on 10/04/2023 11:33 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:PACE PARKWAYFACILITY NUMBER:
486803406
ADMINISTRATOR:STEPHANIE SCOTT-GARLANDFACILITY TYPE:
775
ADDRESS:950 MASON STTELEPHONE:
(707) 447-3767
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY: 75CENSUS: 49DATE:
10/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:47 AM
MET WITH:Britanny Beringer, Program DirectorTIME COMPLETED:
11:45 AM
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On 10/4/2023 Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr inspection for this facility and met with Program Director, Brittany Beringer. The facility is licensed by PACE Solano and currently serves 49 clients, 22 of which were at the facility at the time of visit. The facility is currently conducting partial in-person service program with hybrid options available to some clients. The facility runs on staggered scheduling.

LPA continued with a tour of the facility with Director; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Fire extinguishers were found to be last charged September 29, 2023. Carbon monoxide detector located in main common area was tested and found to be in working order. Vacaville Fire Department conducted fire safety inspection on 7/18/2023 for all exits, safety devices including sprinklers, alarms and smoke and carbon monoxide detectors.

Clients were observed to be engaged in various group activities including, discussion, arts & crafts, large group movie and other options to choose during classroom hours. During the visit, transportation staff and clients were observed preparing to go on outings including visits to local parks and shopping centers. Facility designates several Direct Support Staff to accompany clients by group. Clients observed to have positive relationship with staff continuously engaging and participating with clients. LPA was informed that clients currently provide their own meals with snacks provided throughout the day. Facility also offers scheduled lunch outings scheduled throughout the month. Facility primarily holds outdoor activities during outings and also has a large outdoor parking lot area located in the rear of the building with a basketball hoop and gardening boxes for client use. Toxins, cleaning supplies and other potentially dangerous items are stored in a designated cleaning supply closet inaccessible to clients. All other storage closets and containers holding items that could potentially be a danger to clients if accessible were all found to be locked and secured.

Continue onto LIC809-C
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2023
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: PACE PARKWAY
FACILITY NUMBER: 486803406
VISIT DATE: 10/04/2023
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 LPA also conducted a spot mediation check for clients and found all administration and prescription input records to be in order. Medications were located in designated drawers and all found to be secured in staff office. Facility has contracted with R&D Transportation Services. Water temperature at faucets accessible to clients measured between 108.8 and 116.7 degrees F which is within Title 22 regulations requiring water measurements between 105 and 120 degrees F. LPA conducted a file review of client records and found all items including, program individual plans, personal rights and physician's report to be updated or in order. LPA conducted sample file review of staff records and found all staff to have sufficient CPR & 1st Aid training completed. Recently hired staff have also completed all onboard training with certification on file and are scheduled to completed 1st Aid & CPR training in-person this month.

LPA requested the following documents be sent to CCL by COB 11/4/2023:

LIC 308 Designated Facility Responsibility
LIC 500 Personnel Summary
LIC 610 Emergency Disaster Plan
LIC 9020 Register of Facility Client’s/Resident’s

No deficiencies cited during today's visit.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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