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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 577001513
Report Date: 11/02/2022
Date Signed: 11/02/2022 12:11:09 PM

Document Has Been Signed on 11/02/2022 12:11 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:ADULT TRAINING PROGRAMFACILITY NUMBER:
577001513
ADMINISTRATOR:IRENE RAMIREZFACILITY TYPE:
775
ADDRESS:220 HARTER AVENUETELEPHONE:
(530) 406-0830
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY: 45CENSUS: 23DATE:
11/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Jennifer Vela, Program Coordinator TIME COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived outside of facility to see staff and clients practicing an emergency drill. Everyone had evacuated the building and were outside in their meeting area going through the emergency protocols.

After the drill, LPA met with Jennifer Vela, the Program Coordinator of Adult Training Program. There were twenty-three (23) clients in attendance (in person). There were also three (3) other staff members in attendance. There are still (6) six clients that are participating virtually.

The facility has a central entry point where visitors log in. There are signs posted reminding staff and visitors that they must wear a mask when entering. All staff and visitors are screened and temperatures are taken and documented daily. All staff are vaccinated and possess first aid/CPR certification. Meliza Godinez, Skills Trainer toured the site with LPA. Seating in the main activity room of the facility had 4 staff/clients to a table which had been fitted with clear dividers providing a personal barrier and social distancing.

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. First Aid Kit was mounted to wall and well-stocked with all necessary items.

There are 4 fire extinguishers in the building dated July 13, 2022. There are seven (7) smoke detectors.

No deficiencies during today's inspection.
No citations issued.
Exit interview conducted with Jennifer Vela, Program Coordinator.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/02/2022
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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