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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 577004052
Report Date: 01/06/2023
Date Signed: 01/06/2023 09:40:49 AM

Document Has Been Signed on 01/06/2023 09:40 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:IMPACT CENTER, LLC-WEST SACRAMENTOFACILITY NUMBER:
577004052
ADMINISTRATOR:GRIFFIN, JOETTAFACILITY TYPE:
775
ADDRESS:1834 TERMINAL STREETTELEPHONE:
(916) 373-9740
CITY:WEST SACRAMENTOSTATE: CAZIP CODE:
95691
CAPACITY: 45CENSUS: 24DATE:
01/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Patty Blas, Program ManagerTIME COMPLETED:
09:45 AM
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Licensing Program Analyst Jill Nakagawa conducted 1 year unannounced required inspection and met with Program Manager Patty Blas. The inspection is focused on the Infection Control procedures and practices of this facility.

All visitors, essential visitors, and staff are screened at entry; temperatures are taken, and screening questions are to be answered before being allowed entrance in the facility, all information is logged. Clients are screened before being transported to facility and observed for any changes throughout their attendance, all information is logged. Facility was found to be clean, orderly, with all exits free from obstruction. The facility is a very large space and uses zonal heating. Toxins are stored in locked cabinets. There was a sufficient supply of hygiene products, cleaners, and paper products for use as needed. No medications are kept on site. All bathrooms had signage posted for hand washing guidelines for Covid-19 , paper towels and soap, and covered trash bins. All postings were up and visible to all as required. Facility has a sufficient supply of personal protective equipment (PPE). Program Manager, staff and clients all had a mask on during the LPA's inspection. Mitigation plan was approved by the Department on 08/19/21. Infection Control Plan submitted. (2) Fire extinguishers were serviced and charged on 03/18/22. The Fire Department had performed an inspection on 02/15/22 and the Fire Alarms were inspected on 05/20/21, and an inspection is scheduled for March-April.
There were (7) clients in attendance at the facility during this inspection. There are currently 24 clients, some of whom are serviced remotely.

No deficiencies during today's inspection.
No citations issued.
Exit interview conducted with Patty Blas, Program Manager.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 01/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/06/2023
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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