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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209114
Report Date: 02/15/2024
Date Signed: 02/16/2024 08:20:06 AM

Document Has Been Signed on 02/16/2024 08:20 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:VALLEY ACHIEVEMENT CENTERFACILITY NUMBER:
157209114
ADMINISTRATOR:KEETER, SARAFACILITY TYPE:
775
ADDRESS:7232 MING AVE. SUITE A, C & DTELEPHONE:
(661) 885-8484
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 16CENSUS: 15DATE:
02/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:52 AM
MET WITH:Administrator, Christine EspinozaTIME COMPLETED:
02:44 PM
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Licensing Program Analyst (LPA) Darius Williams conducted an unannounced Annual Inspection. LPA Williams met with Administrator, Christine Espinoza.

Tour began in Suite A, which houses administration and support staff. All rooms and bathrooms were clean and in good repair.

In Suite C LPA observed clients participating in activities with staff. There is a room available for clients to use to have space away from others if needed (locally known as the Calm room). The room is equipped with a couch and other items to assist clients to baseline behavior. All items were in good repair. All clients have cubbies available to store personal items. The bathroom was clean and the toilet was currently clogged and awaiting repair (toilets in attached suites A and C were available for client use). Board games and other activity items were observed in the hallway.

Suite D's layout is exactly the same is B except for the Calm room, which is used as another activity room. Suite D was clean and in good repair.

All sharp and chemical items were locked and inaccessible to clients. There is no centrally stored medication on site. The facility does not provide meals; clients either purchase meals in communities or bring with them. Refrigerators were operational and temperature reflected approximately LPA observed operation carbon monoxide detectors, smoke detectors, and fire extinguishers that were charged. First aid kits were present with all required items.

*Continued on LIC 809C*
SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Darius Williams
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: VALLEY ACHIEVEMENT CENTER
FACILITY NUMBER: 157209114
VISIT DATE: 02/15/2024
NARRATIVE
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LPA Williams reviewed 4 employee files, which had all items requested.

LPA Williams reviewed 4 client files. 1 of 4 files reviewed did not have a medical assessment and tuberculosis status documented. 1 of 4 files did not have an updated Individual Program Plan or Needs and Service Plan.

Based on LPA record review a deficiency is being cited on the attached LIC 809D page.

A plan of correction was review and discussed with Administrator.

An exit interview was conducted and a copy of this report and appeal rights was provided.
SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Darius Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024
LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 02/15/2024 02:49 PM - It Cannot Be Edited


Created By: Darius Williams On 02/15/2024 at 02:21 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: VALLEY ACHIEVEMENT CENTER
FACILITY NUMBER: 157209114

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82069(a)
Client Medical Assessments
(a) Prior to or within 30 calendar days following the acceptance of a client, the licensee shall obtain a written medical assessment of the client that determines the licensee's ability to provide necessary health-related services to the client. The assessment shall be used in developing the Needs and Services Plan.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above in 1 out of 4 which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/16/2024
Plan of Correction
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2
3
4
Administrator contacted Resident 3's authorized representative and requested a negative TB before continuing on site at the program. Administraotr will submit proof of TB to the Department.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
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2
3
4
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:Serigy Pidgirny
LICENSING EVALUATOR NAME:Darius Williams
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/16/2024 08:21 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 02/16/2024 08:16 AM


Created By: Darius Williams On 02/15/2024 at 02:21 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: VALLEY ACHIEVEMENT CENTER
FACILITY NUMBER: 157209114

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Needs and Services Plan
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Serigy Pidgirny
LICENSING EVALUATOR NAME:Darius Williams
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2024


LIC809 (FAS) - (06/04)
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