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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804166
Report Date: 03/19/2024
Date Signed: 03/19/2024 04:19:52 PM

Document Has Been Signed on 03/19/2024 04:19 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:REM SENIOR DAY PROGRAMFACILITY NUMBER:
486804166
ADMINISTRATOR:FELIX, MARYFACILITY TYPE:
775
ADDRESS:3777 VACA VALLEY PARKWAYTELEPHONE:
(707) 640-9700
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY: 40CENSUS: 3DATE:
03/19/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Shawn Parker, Care Associate and Mary Felix, AdministratorTIME COMPLETED:
04:25 PM
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Licensing Program Analysst (LPAs) Jill Nakagawa and Stefanie Mutialu arrived unannounced at REM Day Program for the purpose of conducting a Post-Licensing inspection. LPAs were greeted at the door by caregiver Sean. Mary Felix arrived shortly after. There were 3 clients on site at the time of inspection. Facility is approved for 40 clients which was granted Fire Clearance on 07/06/2023. Mary Felix received Administrator Certificate, # 6033609740, which expires on 01/22/25.

LPAs and Administrator toured the facility. Facility is one story with ample space for activities and socialization. There are 2 restrooms for staff and clients, which are equipped with soap and paper towels, and grab bars in each stall. LPAs observed the facility to be clean and at a comfortable temperature of 72 F with all exits free from obstruction. Fire Extinguishers are dated for 07/03/2023 and are fully charged. Carbon monoxide detector was tested and operational. Sprinkler system is hardwired and signals directly to the fire station. There were a variety of activities laid out for clients to do, including arts and crafts, puzzles, games, and a game show on the TV. They can also do karaoke or take a break in the Quiet Room. Calendar was reviewed during the inspection and found to be appropriate. Resident records, personnel records, medication will be locked in storage cabinet, toxins are kept locked in another storage cabinet. The kitchen is clean and well-organized and supplied with drinks and snacks. Clients will be providing their own lunches. There is an adequate supply of emergency supplies.
1 Client and 1 Personnel File were reviewed and found to be complete.
No deficiencies were found at the time of inspection. No citations were issued.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 03/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2024
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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