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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 572700336
Report Date: 07/12/2024
Date Signed: 07/12/2024 11:21:18 AM

Document Has Been Signed on 07/12/2024 11:21 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:TRUE CONNECTIONS COMMUNITY PROGRAMS, INCFACILITY NUMBER:
572700336
ADMINISTRATOR/
DIRECTOR:
TRUE, CYNTHIAFACILITY TYPE:
775
ADDRESS:405 L STTELEPHONE:
(530) 753-3089
CITY:DAVISSTATE: CAZIP CODE:
95616
CAPACITY: 30CENSUS: 28DATE:
07/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Cynthia True, AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct a 1 Year- Required Annual Inspection. There were 10 staff and 23 clients at this Adult Day Program at the time of inspection.

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. LPA conducted a walk-through of the facility and found it to be clean, well-organized and a comfortable temperature of 74 F. The facility has 4 Smoke/Carbon Monoxide detectors which were operational at the time of inspection, but are being replaced in August, 2024. There were 2 Fire Extinguishers which were fully charged and last serviced on 04/12/2024. The bathrooms were clean and sanitary, and were supplied with soap and paper towels, toilet paper and covered trash containers. Part of the Program Plan and Infection Control Plan include clients cleaning the bathroom after they use, including using disinfectants. Clients have been trained in their use and are supervised by staff. The kitchen was clean and well-organized, with lots of space for clients to participate in cooking activities. There is a craft and sewing area with lots of room for cutting, sewing and ironing. Activities include cooking, music, sewing, educational, vocational training and volunteer work. LPA observed all staff and clients fully engaged in the program.

LPA conducted review of 5 staff and 5 client files and found them to be complete. Staff had required first aid/cpr certification.

LPA requested the following: LIC500, Proof of Liability Insurance.

No deficiencies found at the time of this inspection.


No citations issued.

Exit interview conducted with Cynthia True, whose signature on this document confirms receipt.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2024
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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