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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 150406303
Report Date: 07/17/2024
Date Signed: 07/19/2024 01:16:35 PM

Document Has Been Signed on 07/19/2024 01:16 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:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Brenda Rodriguez, Program CoordinatorTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
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On 7/17/24, Licensing Program Analysts (LPAs) M Medina and L. Salazar arrived to the Day Program unannounced to conduct the required annual inspection. LPAs stated the purpose of the visit and were allowed entry into the facility. LPAs met with Program Director who conducted the tour of the facility with LPA Salazar and LPA Medina.

LPA Medina reviewed a sample of staff and client files.

LPA Salazar will document the physical plant tour and inspection tool results on a separate report.

Exit interview conducted. No deficiencies cited.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
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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