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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206908
Report Date: 08/14/2023
Date Signed: 08/14/2023 01:37:31 PM

Document Has Been Signed on 08/14/2023 01:37 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:LIFE SKILLS AND VOCATIONAL CENTERFACILITY NUMBER:
157206908
ADMINISTRATOR:BOLANOS,M.& MACHADO, JOSEFACILITY TYPE:
775
ADDRESS:1414 GARCES HIGHWAYTELEPHONE:
(661) 721-3220
CITY:DELANOSTATE: CAZIP CODE:
93215
CAPACITY: 50CENSUS: 38DATE:
08/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Ricardo Banuelos, Program Coordinator TIME COMPLETED:
01:45 PM
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On 08/14/23, 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 9 out of 38 clients to be present and ambulatory at the facility during the inspection. 29 out of 38 clients were out of the facility, participating in their Community Based program.

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 77 degrees F. Disinfectants and cleaning supplies were observed to be locked in a closet and inaccessible to clients.

Emergency disaster plan and procedures are in place. Last fire drill was conducted on 07/11/23. The outside of the facility was toured. LPA observed seating in shaded areas and water coolers are available for each client group in care. Doors and passageways were observed to be free from obstruction throughout the program. Four fire extinguishers were observed with an expiration date 07/24/23. Smoke and Carbon Monoxide detector were present in the kitchen.

LPA requested the following updated forms to be faxed to CCLD by 8/28/23: Designation of Facility Responsibility (LIC308), Administrative Organization (LIC309), Personnel Report (LIC 500), Client Roster (LIC 9020), and Emergency Disater Plan (LIC 610D) No deficiencies cited on today's visit.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 08/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/14/2023
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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