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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 572700336
Report Date: 07/07/2022
Date Signed: 07/07/2022 03:52:54 PM

Document Has Been Signed on 07/07/2022 03:52 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:TRUE CONNECTIONS COMMUNITY PROGRAMS, INCFACILITY NUMBER:
572700336
ADMINISTRATOR:TRUE, CYNTHIAFACILITY TYPE:
775
ADDRESS:405 L STTELEPHONE:
(530) 753-3089
CITY:DAVISSTATE: CAZIP CODE:
95616
CAPACITY: 30CENSUS: 23DATE:
07/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Samantha Wood, Program DirectorTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct a 1 Year- Required Annual Inspection. This inspection will be focused on the Infection Control procedures and practices of this Adult Day Program. Currently, the facility is providing in-person services for 23 -30 clients (approximately) as well alternative services for 9 clients such as activity bags, outside activities, virtual classes (cooking, music, sewing, educational, etc) and virtual visits. There were no clients at the time of this inspection as program had already ended for the day.

Upon arrival, LPA observed a screening station at the entrance of facility which had hand sanitizer, a thermometer, and a sign-in sheet. LPA's temperature was documented on the sign-in sheet. Staff and visitors are screened for COVID-19 symptoms (including temperature check) upon arrival to the facility. LPA conducted a walk-through of the facility with Program Director and observed COVID-19 precaution postings. The facility was clean, well-organized and a comfortable temperature. Staff clean the facility daily and high touched surfaces are disinfected after use. The facility has a designated visitation area. Facility staff have completed PPE training.

The facility has submitted their COVID-19 Mitigation Plan, as well as the Infection Control Plan to Community Care Licensing. LPA observed a supply of PPE including gloves, face shields, KN-95s, disinfectant wipes, and surgical masks. Staff and clients wore face masks during the visit.

Exit interview conducted with Program Director, whose signature on this document confirms receipt.



No deficiencies found at the time of this inspection.
No citations issued.

Exit interview conducted with Program Director, whose signature on this document confirms receipt.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 07/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/07/2022
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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