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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206787
Report Date: 05/19/2023
Date Signed: 05/19/2023 12:24:52 PM

Document Has Been Signed on 05/19/2023 12:24 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, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:CENTRAL VALLEY TRAINING CENTER FRESNO WESTFACILITY NUMBER:
107206787
ADMINISTRATOR:ROBERT AGUILARFACILITY TYPE:
775
ADDRESS:3685 W HOLLAND AVETELEPHONE:
(559) 228-8696
CITY:FRESNOSTATE: CAZIP CODE:
93722
CAPACITY: 105CENSUS: 69DATE:
05/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Megan WilliamsTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Katie Brown arrived unannounced to conduct the Annual Inspection.
LPA met with and explained the purpose of the visit with Program Director (PD) Megan Williams.

During this visit, LPA toured the Day Program inside and out with PD. Clients were observed in classroom groups throughout the program with assigned instructors providing supervision. LPA observed hand washing signs as well as required items in client restrooms as well as hand sanitizer throughout. Client medication was locked and stored in PD office. Medication procedures and Centrally Stored logs were reviewed. The day program grounds are clean and in good repair. Disinfectants and cleaning supplies were locked and inaccessible to clients. Outside was toured and LPA observed a self-releasing gate. Doors and passageways are unobstructed throughout the program. Fire Extinguishers dated 5/9/23. Smoke and Carbon Monoxide detectors present and in working order. LPA conducted resident and staff file reviews and interviews.

There were no citations issued during this inspection.

An exit interview was conducted and a copy of this report was left with PD, whose signature confirms receipt of this report.



LPA requested the following updated forms faxed to CCLD by 5/26/23 : Designation of Facility Responsibility (Lic308), Administrative Organization (Lic309), Affidavit Regarding Client/Resident Cash Resources (LIC 400), Surety Bond (Lic402), Emergency Disaster Plan (Lic610D 12/21 version), Personnel Report (LIC 500).
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Katie Brown
LICENSING EVALUATOR SIGNATURE: DATE: 05/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/19/2023
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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