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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804166
Report Date: 08/07/2024
Date Signed: 08/07/2024 10:59:24 AM

Document Has Been Signed on 08/07/2024 10:59 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:REM SENIOR DAY PROGRAMFACILITY NUMBER:
486804166
ADMINISTRATOR/
DIRECTOR:		FELIX, MARYFACILITY TYPE:
775
ADDRESS:3777 VACA VALLEY PARKWAYTELEPHONE:
(707) 640-9700
CITY:VACAVILLESTATE: CAZIP CODE:
95688
CAPACITY: 40CENSUS: DATE:
08/07/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:25 AM
MET WITH:Mary Felix (Administrator)TIME VISIT/
INSPECTION COMPLETED:
11:14 AM
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Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct an Annual Required Inspection and met with Administrator, Mary Felix. The program is open to clients Mondays through Fridays from 7:00 am to 7:00 pm. Required postings were observed. Contact information reviewed. Annual fees are current.

LPA initiated a tour of the facility at 9:30 am and made the following observations: Facility is one story with ample space for activities and socialization. Facility was a comfortable temperature and passageways were free from obstructions. Five participants were engaged in activities at the time of visit. The day program operates out of a primary room within the main building and participants bring their own meals. Program maintains a supply of drinks and snacks. There are two bathrooms available for participants to use and exterior space. Water temperature in bathroom measured at 119.3 and 118.6 degrees F which is within allowable range of 105 to 120 degrees F. Bathrooms were equipped with grab bars to ensure safety. Toxins were inaccessible to participants in care. Facility does not handle medications for day program participants upon family request it and they do not provide transportation. Fire extinguisher was last inspected 7/1/24. The sprinkler system is hardwire and maintained by Fire Code and the most recent test was completed in 7/1/24. Most recent Fire/Disaster drill was conducted October, 2023 (technical advisory issued). Carbon monoxide was operational.

LPA initiated file review at 10:00am. Three staff files and five participant files were reviewed. Staff have required First Aid/CPR certificates and required annual training hours completed. Care plan and medical assessments are updated.

Administrator provided updates of the following documents: Designation of Administrative Responsibility (LIC308) and Personnel Report (LIC500).

No deficiencies cited during today's inspection. Exit interview conducted with Administrator and copy was provided.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE: DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/07/2024
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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