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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 150406303
Report Date: 08/28/2023
Date Signed: 08/29/2023 09:12:05 AM

Document Has Been Signed on 08/29/2023 09:12 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, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:ACHIEVEMENT CENTER, THEFACILITY NUMBER:
150406303
ADMINISTRATOR:BOLANOS, MARIOFACILITY TYPE:
775
ADDRESS:531 HIGH STREETTELEPHONE:
(661) 721-3222
CITY:DELANOSTATE: CAZIP CODE:
93215
CAPACITY: 60CENSUS: 54DATE:
08/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Mario Bolanos, Administrator TIME COMPLETED:
12:45 PM
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On 08/28/23, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to conduct the required annual inspection. LPA was greeted by Program Coordinator, stated the purpose of the visit, and was allowed entry into the facility.

LPA toured the facility inside and out. LPA observed the required hand washing signs in client restrooms. An updated Infection Control plan was received prior to LPA's inspection. LPA observed the facility to be clean and free from odor. Facility temperature measured at 74 degrees F. Disinfectants and cleaning supplies were observed to be locked in an inaccessible to clients.

Emergency disaster plan and procedures are in place. Last fire drill was conducted on 05/24/23. The outside of the facility was toured. LPA observed seating in shaded areas for clients in care. Doors and passageways were observed to be free from obstruction throughout the program. Fire extinguishers were observed with an expiration date 04/20/23. Client and staff files will be reviewed at a later date.

LPA requested the following updated forms to be faxed to CCLD by 9/11/23: Designation of Facility Responsibility (LIC308), Personnel Report (LIC 500), Client Roster (LIC 9020), and Emergency Disaster Plan (LIC 610D) No deficiencies cited on today's visit.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2023
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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