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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503808289
Report Date: 07/02/2019
Date Signed: 07/02/2019 01:29:56 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:CHILDREN'S CRISIS CENTER-VERDA'S HOUSEFACILITY NUMBER:
503808289
ADMINISTRATOR:GARCIA,COLLEENFACILITY TYPE:
840
ADDRESS:715 E. MAINTELEPHONE:
(209) 656-7783
CITY:TURLOCKSTATE: CAZIP CODE:
95380
CAPACITY:7CENSUS: 5DATE:
07/02/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Respite Program Coordinator-Jessica RamseyTIME COMPLETED:
01:45 PM
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On this date, Licensing Program Analyst (LPA) Luisa Gavoutian conducted an unannounced case management - incident inspection. LPA met with Respite Program Coordinator, Jessica Ramsey, and Program Site Manager, Rosa Borba, toured the facility, and took a census. The purpose of today's inspection was to follow-up on an unusual incident that was reported to Community Care Licensing (CCL) on June 4, 2019.

During today's inspection, LPA interviewed staff regarding the incident. Facility met all reporting requirements as specified in Title 22 Regulation 101212 - Reporting Requirements. Facility made all required cross-reports and copies were submitted to CCL. The incident is an isolated incident and not a result of lack of care and supervision.

No deficiencies cited in the areas observed today.

This report is to be made available to the public upon request.
LIC 9213 Notice of Site Visit to be posted for 30 days.
SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Luisa GavoutianTELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2019
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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