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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 577001513
Report Date: 11/16/2021
Date Signed: 11/16/2021 10:59:25 AM

Document Has Been Signed on 11/16/2021 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:ADULT TRAINING PROGRAMFACILITY NUMBER:
577001513
ADMINISTRATOR:IRENE RAMIREZFACILITY TYPE:
775
ADDRESS:220 HARTER AVENUETELEPHONE:
(530) 406-0830
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY: 45CENSUS: 28DATE:
11/16/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:43 AM
MET WITH:Melanie Ramirez, Skills Trainer,
Meliza Godinez, Skills Trainer		TIME COMPLETED:
10:59 AM
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Licensing Program Analyst (LPA) Jill Nakagawa (JN) arrived unannounced to the Adult Training Program at approximately 9:43 AM on November 16, 2021 to perform an annual inspection concentrating on infection control procedures.

There were approximately 28 clients and 4 staff members on site. There were two other staff members attending training off site during LPA's visit. Meliza Godinez, Skills Trainer toured the site with LPA. All staff and clients were observed to be wearing masks. All staff and visitors are screened and temperatures are taken and documented daily. All staff are vaccinated and possess first aid/CPR certification. Seating provided by the facility had 4 staff/clients to a table which had been fitted with clear dividers providing a personal barrier and social distancing. Each client has their own hand sanitizer at their assigned seat.

Clients are picked up each morning and screened before they are allowed on transportation vans. Vans are cleaned and sanitized at the end of each day. Clients bring their own lunches which are stored on shelves. Bathrooms and sinks are outfitted with soap, hand sanitizer and paper towels. There is Covid-19 Prevention signage as well as hand washing posters at all entrances, sinks and bathrooms.

There are 4 fire extinguishers in the building dated July 16, 2021. There are seven (7) smoke detectors.

No deficiencies during today's inspection.
No citations issued.
Exit interview conducted with Meliza Godinez, Skills Trainer.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2021
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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