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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 150406303
Report Date: 07/17/2024
Date Signed: 07/18/2024 04:15:14 PM

Document Has Been Signed on 07/18/2024 04:15 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:ACHIEVEMENT CENTER, THEFACILITY NUMBER:
150406303
ADMINISTRATOR/
DIRECTOR:		BOLANOS, MARIOFACILITY TYPE:
775
ADDRESS:531 HIGH STREETTELEPHONE:
(661) 721-3222
CITY:DELANOSTATE: CAZIP CODE:
93215
CAPACITY: 60CENSUS: 55DATE:
07/17/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Program Director, Mario Bolanos
Program Manager, Brenda Rodriguez 		TIME VISIT/
INSPECTION COMPLETED:
11:30 AM
NARRATIVE
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On 07/17/2024, Licensing Program Analysts (LPAs) L. Salazar and M. Medina arrived at the facility unannounced to conduct the annual required visit. LPAs were greeted by the Program Manager (PM), stated the purpose of the visit and were allowed entry into the facility.

LPAs toured the facility inside and out. Facility was observed to have 4 rooms (3 classrooms & 1 kitchen) and 4 bathrooms. LPA observed 10 staff members present at the facility. First Aid kit observed. Water temperature measured at 108 degrees F.

LPA observed the facility to be in need of deep cleaning and painting on and around the doors/doorframes. Floor located between the bathrooms near the exit door is uneven and cracked and needs replacement. Facility was free from odor. Facility temperature measured at 74 degrees F. Disinfectants/cleaning supplies (Fabuloso) were observed to be unlocked in the cabinets located in the main women's bathroom. Chemicals were removed and placed in a locked janitor closet at the time of visit.

Emergency disaster plan and procedures are in place. Last fire drill was conducted on 5/23/2024. Doors and passageways were observed to be free from obstruction. Fire extinguishers were observed with a service date of 04/23/24. Client and staff files will be reviewed by LPA Medina at the main office and documented on an annual continuation visit.

Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 809-D. An exit interview was conducted with Program Director and Program Supervisor. A copy of this report and appeal rights were provided via email. A plan of correction was developed with a due date if 08/09/24.

LPA requested the following updated forms to be faxed to CCLD by 08/02/24: Designation of Facility Responsibility (LIC308), Administrative Organization (LIC309), Personnel Report (LIC 500), Client Roster (LIC 9020) and Emergency Disaster Plan (LIC 610D).


SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 07/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/17/2024
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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Document Has Been Signed on 07/18/2024 04:15 PM - It Cannot Be Edited


Created By: Lisa Salazar On 07/17/2024 at 02:56 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: ACHIEVEMENT CENTER, THE
FACILITY NUMBER: 150406303

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/17/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82087(a)(3)
Buildings and Grounds
(a) The program site shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. (3) Disinfectants, cleaning solutions, poisons, and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observation during facility tour, the licensee did not comply with the section cited above in which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/19/2024
Plan of Correction
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Administrator will provide LPA with the scheduled date for an all staff inservice training on safeguarding immediate and potential hazards to individuals in care. Training will be completed within 10 days of the POC. (08/01/24).
Program Director will conduct repairs/replacements, deep cleaning and/or painting of the facility throughout by POC date of 08/09/24.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Melinda Hoffmann
LICENSING EVALUATOR NAME:Lisa Salazar
LICENSING EVALUATOR SIGNATURE:
DATE: 07/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/17/2024


LIC809 (FAS) - (06/04)
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