<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206908
Report Date: 06/04/2024
Date Signed: 07/01/2024 06:36:49 AM

Document Has Been Signed on 07/01/2024 06:36 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:LIFE SKILLS AND VOCATIONAL CENTERFACILITY NUMBER:
157206908
ADMINISTRATOR/
DIRECTOR:
BOLANOS,M.& MACHADO, JOSEFACILITY TYPE:
775
ADDRESS:1414 GARCES HIGHWAYTELEPHONE:
(661) 721-3220
CITY:DELANOSTATE: CAZIP CODE:
93215
CAPACITY: 50CENSUS: 40DATE:
06/04/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:10 PM
MET WITH:Jose Mercado, Program Director TIME VISIT/
INSPECTION COMPLETED:
02:26 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 06/04/24, 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. Program Director arrived shortly after.

LPA toured the facility inside and out. LPA observed 10 out of 40 clients to be present and ambulatory at the facility during the inspection. 30 out of 40 clients were out of the facility, participating in their Community Based program.

LPA observed the required hand washing signs in client restrooms. The facility was observed to be free from odor. Facility temperature measured at 78 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 drill was earthquake and was conducted on 02/14/24. The outside of the facility was toured. LPA observed seating in shaded areas and water coolers are available for clients in care. Doors and passageways were observed to be free from obstruction throughout the program. Four fire extinguishers were observed with an expiration date 07/24/24. Smoke and Carbon Monoxide detector were present in the kitchen. Staff and client records will be reviewed at the main office and will be documented on an annual continuation report.

LPA requested the following updated forms to be faxed to CCLD by 06/21/24: Personnel Report (LIC 500), Client Roster (LIC 9020), and Emergency Disaster Plan (LIC 610D). An exit interview was conducted with Program Director and a copy of this report was sent via email.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 06/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/04/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1