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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157200175
Report Date: 06/21/2024
Date Signed: 07/01/2024 06:38:00 AM

Document Has Been Signed on 07/01/2024 06:38 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:ACESFACILITY NUMBER:
157200175
ADMINISTRATOR/
DIRECTOR:		IRVING, CONNIEFACILITY TYPE:
775
ADDRESS:612 MAIN STREETTELEPHONE:
(661) 721-3220
CITY:DELANOSTATE: CAZIP CODE:
93215
CAPACITY: 90CENSUS: 24DATE:
06/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:03 PM
MET WITH:Alicia Lopez, AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:49 PM
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On 06/20/24, 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. 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 a janitor closet and inaccessible to clients.

Emergency disaster plan and procedures are in place. Last fire drill was conducted on 5/2024. Doors and passageways were observed to be free from obstruction throughout the program. Fire extinguishers were observed with an expiration date 04/23/24. Client and staff files will be reviewed at a later date because the main office is closed and clients have left the program with the exception of 4 individual.

LPA requested the following updated forms to be faxed to CCLD by 7/05/24: Designation of Facility Responsibility (LIC308), Administrative Organization (LIC309), Personnel Report (LIC 500), Client Roster (LIC 9020) that identifies which individuals resident in an Intermediate Care Facility (ICF's), 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: 06/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2024
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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