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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803735
Report Date: 04/26/2022
Date Signed: 04/26/2022 12:12:52 PM

Document Has Been Signed on 04/26/2022 12:12 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:EQUIVENTURE DAY PROGRAMFACILITY NUMBER:
486803735
ADMINISTRATOR:DINGLASAN, CYNTHIAFACILITY TYPE:
775
ADDRESS:258 SUNSET AVE. STE. MTELEPHONE:
(707) 759-3888
CITY:SUISUN CITYSTATE: CAZIP CODE:
94585
CAPACITY: 45CENSUS: 11DATE:
04/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Leonila BunyiTIME COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Walters arrived unannounced for the purpose of conducting a Required 1-Year annual inspection. LPA met with Program Manager, Leonila Bunyi (LB). This visit will focus on the infection control of this facility. At the time of inspection there were 13 staff and 2 Nurses providing care and supervision for clients in care. This day program is currently offering in person and alternative services.

The facility has designated one-single entry point, in which LPA entered and was greeted by staff. LB checked LPA's temperature and signed them in on sign-in sheet. The sign-in sheet included screening questions. Facility staff and clients are also screened prior to entry. Clients are screened twice; once prior to being transported to the facility, and again after they have arrived. Screenings are documented in a binder at the entrance. All staff were wearing face coverings. Clients were socially distanced in the common area, and engaged in activities with staff. Per LB, after clients have completed activities, all activities are sanitized using Hiro sanitizer gun. There was also a Hiro sanitizing misters to remove bacteria from clothing items and air in the common area for clients. Bathrooms were stocked with hand washing supplies and paper towel. Signs were posted in the bathroom and throughout the facility to promote droplet precaution and hand washing. LPA reviewed 5 staff and 5 client records. 5 of 5 Staff records included, training on airborne illnesses, review of each clients care plan and the prevention of COVID-19. Staff records also included their vaccine cards, health screening, and proof of fit testing. 5 of 5 client records included vaccine cards, with booster information.
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SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Katrina Walters
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2022
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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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: EQUIVENTURE DAY PROGRAM
FACILITY NUMBER: 486803735
VISIT DATE: 04/26/2022
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Continued from 809

Smoke detectors, Carbon Monoxide detectors and sprinklers were last tested by the fire department. Fire Extinguishers were last serviced 03/21/2022.

The facility previously submitted a mitigation plan that was approved by Community Care Licensing, but since then, there have been updated regulatory requirements related to infection control prevention and mitigation for communicable diseases. LB understands that the facility will need to submit an updated mitigation plan by 6/30/22. LPA and LB discussed new requirements in PIN 22-13 ASC.

There were no citations issued during today's inspection. Exit interview completed with Program Manager. A copy was provided.
SUPERVISORS NAME: Hope DeBenedetti
LICENSING EVALUATOR NAME: Katrina Walters
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2022
LIC809 (FAS) - (06/04)
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