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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 577001513
Report Date: 12/06/2024
Date Signed: 12/06/2024 03:07:31 PM

Document Has Been Signed on 12/06/2024 03:07 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/
DIRECTOR:
JENNIFER VELAFACILITY TYPE:
775
ADDRESS:220 HARTER AVENUETELEPHONE:
(530) 406-0830
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY: 45CENSUS: 32DATE:
12/06/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:58 PM
MET WITH:Jennifer Vela, AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:07 PM
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On 12/06/2024, Licensing Program Analyst (LPA) Jill Nakagawa, arrived at the facility unannounced to conduct a 1-Year Required Annual Inspection. Adult Training Program provides a Day Program and opportunities for clients to receive work experience. LPA met with Facility Administrator, Jennifer Vela, and explained the purpose of the visit.

LPA and Administrator toured facility to ensure health and safety of clients in care. Areas toured included the large Common Room, restrooms, and outdoor activity yard. LPA observed the facility to be clean, in good repair and odor-free. Each bathroom had soap, paper towels and a trashcan. In common area, LPA observed 2 large sinks and a stove and microwave oven and 2 refrigerators for staff and client use although clients bring their own lunch daily in lunch boxes, stored on shelves in the Common Room.

Hot water temperature measured 113 degrees F, which is within the required range. LPA observed several fire extinguishers last serviced on 07/26/2024, and were fully charged. Facility was inspected by Fire Department on 06/05/2024. Smoke detectors and carbon monoxide detectors throughout the facility were operational at the time of inspection. LPA observed the first aid kit to be complete and ready for use.

LPA reviewed a total of (5) clients' files and (5) staff files which contained all the required documentation.

Several topics were discussed.

No deficiencies are being cited as a result of today’s inspection.

Exit interview conducted and copy of report left at the facility.

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2024
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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