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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701333
Report Date: 02/14/2024
Date Signed: 02/14/2024 01:15:39 PM

Document Has Been Signed on 02/14/2024 01:15 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:COMMUNITY EXPERIENCE CENTER INCFACILITY NUMBER:
502701333
ADMINISTRATOR:KING, DEREKFACILITY TYPE:
775
ADDRESS:5933 STODDARD RD BUILDING 11TELEPHONE:
(209) 918-5482
CITY:MODESTOSTATE: CAZIP CODE:
95357
CAPACITY: 135CENSUS: DATE:
02/14/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Derek King and Saudia WhitakerTIME COMPLETED:
01:30 PM
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On 2/14/24 Licensing Program Analyst (LPA) Maja Jensen arrived at facility announced to conduct a pre-licensing visit. LPA Jensen met with Derek King and Saudia Whitaker and explained the purpose of today's visit.

LPA Jensen toured the physical plant and grounds. The grounds are well maintained and all pathways are free of obstruction. There are benches and shaded areas available. There are no bodies of water on the property. The physical plant was observed to be sanitary and all furnishings and appliances were observed to be in good repair. The facility has a large main common room that is surrounded by offices and classrooms around the perimeter. The facility has created classrooms for computer skills, music, health and wellness, employment skills and cooking and other skills. The facility also has a coffee bar area, beauty salon, reading lounge, movie theater, arcade room, quiet room and store. The program design includes a point system wherein participants earn points for attending classes that can be redeemed in the store for items like T-shirts and hoodies or gifts for friends and family. In addition to the themed activity areas there are games and supplies on hand for participant engagement.

The facility has a fully immersive warming kitchen and will be serving meals. The kitchen does not include any equipment for frying. Hot meals will be made in crock pots or the oven. There is a commercial refrigerator and freezer and a sanitizing dishwasher. The meal recipes are from myplate.gov and all recipes include data on sodium, carbohydrates etc..

The facility has an emergency disaster plan that was reviewed and is in compliance. The facility intends to retain a nurse on staff if needed to assist participants with any health conditions. There is an emergency disaster cart and medication cart in the nurses office and a refrigerator solely for medication. All trash cans have tight fitting lids. There is a separate storage area for chemicals

Continued on LIC 809C....
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: COMMUNITY EXPERIENCE CENTER INC
FACILITY NUMBER: 502701333
VISIT DATE: 02/14/2024
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The fire extinguisher was last in August of 2023. The smoke detectors are functional within the air ducts of the building. There are facility sketches and evacuation routes posted in every classroom and the common area. The building is equipped with a fire protection sprinkler system. There is a first aid kit that is complete and in compliance. The facility does not currently have an AED. The water temperature in the participant bathrooms was measured and is in compliance.

The inspection tool was utilized during the course of this inspection. The facility is in substantial compliance. A component III presentation was conducted. The Licensee has passed the pre-licensing inspection.

An exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2024
LIC809 (FAS) - (06/04)
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