<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 577004052
Report Date: 01/17/2024
Date Signed: 01/17/2024 11:51:49 AM

Document Has Been Signed on 01/17/2024 11:51 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: DATE:
01/17/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Patty Blas, Program DirectorTIME COMPLETED:
11:58 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst Jill Nakagawa conducted an unannounced 1 year required inspection and met with Program Manager Patty Blas. There were 18 clients participating this day. There were 10 staff on duty.

Facility was found to be clean, orderly, with all exits free from obstruction. The facility has two very large activity rooms, several small rooms for quiet time and/or individual activities. Toxins are stored in locked cabinets. There was a sufficient supply of hygiene products, cleaners, and paper products for use as needed. Medications are stored and locked in Program Manager's office. All bathrooms had signage posted for hand washing guidelines and are equipped with paper towels, soap, and covered trash bins. Facility has a sufficient supply of personal protective equipment (PPE). Infection Control Plan submitted. Four fire extinguishers were serviced and charged on 03/15/2023. The Fire Department had performed an inspection on 03/31/2023 and the Fire Alarm System was inspected on 03/15/2023. Clients were bowling at the time of inspection and the facility provides a variety of activities each day, including going to the movies, arts and crafts, games, and sporting events.
Clients bring their lunch each day and are able to store them in refrigerator if necessary.

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: 01/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1