Community Care Licensing

Document Has Been Signed on 08/24/2023 01:56 PM - It Cannot Be Edited

FACILITY NAME:	SEQUOIA ADULT ACTIVITY CENTER		FACILITY NUMBER:	547208766
ADMINISTRATOR:	CONLEY, LORRIE		FACILITY TYPE:	775
ADDRESS:	1329 N ALTA AVE		TELEPHONE:	(559) 315-5351
CITY:	DINUBA	STATE: CA	ZIP CODE:	93618
CAPACITY: 30		CENSUS: 20	DATE:	08/24/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:09 AM
MET WITH:	Lorrie Conley, Administrator		TIME COMPLETED:	02:15 PM

SUPERVISORS NAME: Melinda Hoffmann LICENSING EVALUATOR NAME: Malia Thao LICENSING EVALUATOR SIGNATURE: DATE: 08/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/24/2023

Link to Parent Document Below:

FACILITY NAME: SEQUOIA ADULT ACTIVITY CENTER	FACILITY NUMBER: 547208766
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/24/2023

Type A

Section Cited

CCR

82087(f)

(f) Licensees serving clients who have physical handicaps, mental disorders, or developmental disabilities shall ensure the inaccessibility of pools, including swimming pools (in-ground and above-ground), fixed-in-place wading pools, hot tubs, spas, fish ponds or similar bodies of water through a pool cover or by surrounding the pool with a fence. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above. LPA observed the south side gate lever lock to pool area was broken and unable to lock; and deadbolt of same south side gate was not locked, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 08/24/2023
	Plan of Correction
1 2 3 4	During the inspection, Administrator obtained the key and locked the deadbolt. POC cleared during the inspection.

Section Cited

	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

SUPERVISOR'S NAME: Melinda Hoffmann LICENSING EVALUATOR NAME: Malia Thao LICENSING EVALUATOR SIGNATURE: DATE: 08/24/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/24/2023

Link to Parent Document Below:

FACILITY NAME: SEQUOIA ADULT ACTIVITY CENTER	FACILITY NUMBER: 547208766
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/24/2023

Type B

Section Cited

CCR

82087(a)

(a) The program site shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above. Right side fence panel of south side pool fence observed with missing screws in top left and bottom right sides, creating an unsecured fence panel; outlet in bathroom observed with a broken face plate exposing interior of wall; and latch of north side exit gate observed loose with exposed nails, which poses a potential safety or personal rights risk to persons in care.
	POC Due Date: 08/31/2023
	Plan of Correction
1 2 3 4	Administrator will install new screws to secure right side fence panel of south side pool fence, install new face plate to outlet in bathroom, and repair latch and exposed nails of north side exit gate by POC due date. LPA will return for a POC visit.

Type B

Section Cited

CCR

82087(a)(3)

(a) The program site shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. (3) Disinfectants, cleaning solutions, poisons, and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above. Garage door and access door from inside facility to garage observed opened/accessible and garage is where tools/lawn equipment/paint cans are stored; and two shovels and combo hand digger/hoe observed accessible in backyard, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/31/2023
	Plan of Correction
1 2 3 4	During the inspection, Administrator removed the two shovels and combo hand digger/hoe to the garage; and closed the garage door. Administrator will switch the garage access door's lock doorknob so that the doorknob can be locked with a key from inside the facility, by the POC due date. LPA will return for a POC visit.

SUPERVISOR'S NAME: Melinda Hoffmann LICENSING EVALUATOR NAME: Malia Thao LICENSING EVALUATOR SIGNATURE: DATE: 08/24/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/24/2023