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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 577004734
Report Date: 03/11/2022
Date Signed: 03/11/2022 10:09:01 AM

Document Has Been Signed on 03/11/2022 10:09 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:REACH ADULT DEVELOPMENT SITE #6FACILITY NUMBER:
577004734
ADMINISTRATOR:SUH, SEANFACILITY TYPE:
775
ADDRESS:921 JEFFERSON BLVDTELEPHONE:
(916) 203-6246
CITY:WEST SACRAMENTOSTATE: CAZIP CODE:
95691
CAPACITY: 30CENSUS: 29DATE:
03/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Nati Mauga, ManagerTIME COMPLETED:
10:15 AM
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Licensing Program Analyst Jill Nakagawa conducted an unannounced Annual Required – 1 yr. Infection Control inspection to this facility and met with Facility Manager, Nati Mauga. At the time of inspection there were 2 staff providing services for 3 clients; on Mondays and Tuesdays there are 9 clients in person with 4 staff and Manager. Wednesdays are strictly Zoom meetings for the clients, with all 4 staff plus 1 manager at the facility.

LPA observed that proper signage was posted at the entrance and throughout the facility to promote hand washing and social distancing. Upon entry, LPA's temperature was checked; and logged in binder where staff, clients and visitors temperatures and screening questions are kept. The facility was found to be clean. The temperature was a little cold (65) but there was a heater going which made proximal temperature quite comfortable. The building really heats up on its own at 11 AM, and then it is hard to cool down. The facility exits were free from obstructions. There was one entry point at the front of the building for the facility.

LPA toured the facility with NM. Staff also participate in daily temperature check, and screening prior to entry. Bathrooms were stocked with paper towel and hand washing supplies. All Staff were wearing masks. The facility has a designated isolation room for any asymptomatic or symptomatic clients. Clients' emergency contact information has been updated and Emergency Personnel numbers are posted at the facility. The facility mitigation plan was reviewed and approved on 05/07/2021.

No deficiencies cited during today's inspection.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2022
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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