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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 160403663
Report Date: 08/28/2024
Date Signed: 08/28/2024 11:54:54 AM

Document Has Been Signed on 08/28/2024 11:54 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:KINGS REHABILITATION CENTER, INC.FACILITY NUMBER:
160403663
ADMINISTRATOR/
DIRECTOR:		ACOSTA, SUSANFACILITY TYPE:
775
ADDRESS:490 E. HANFORD ARMONA ROADTELEPHONE:
(559) 582-9234
CITY:HANFORDSTATE: CAZIP CODE:
93230
CAPACITY: 100CENSUS: DATE:
08/28/2024
TYPE OF VISIT:Case Management - IncidentANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Administrator-Susan CastroTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
NARRATIVE
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On 8/28/24, Licensing Program Analyst (LPA) J. Leffall conducted a case management – incident visit to follow up on an incident report received in the Regional Office on 8/23/24. LPA met with Administrator (A1) Susan Acosta and stated the purpose of the visit.

Per records reviewed of the incident report and the interview conducted with the client (C1), LPA confirmed that 1 staff and 1 client at the Day Program allowed a client (C1) to purchase gifts for them and items for work. C1 made ongoing purchases for 3 years, totaling $5000.00.

Deficiency is cited on the attached 809-D per Title 22. Exit interview was conducted and Appeal Rights were provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Jacques Leffall
LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2024
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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Document Has Been Signed on 08/28/2024 11:54 AM - It Cannot Be Edited


Created By: Jacques Leffall On 08/28/2024 at 11:11 AM
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: KINGS REHABILITATION CENTER, INC.
FACILITY NUMBER: 160403663

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/05/2024
Section Cited
CCR
82065(I)

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82065(I) Personnel Requirements - Personnel shall provide for the care and safety of persons without physical or verbal abuse, exploitation, or prejudice. This requirement was not met as evidenced by:

Based on records reviewed and interviews conducted, it was confirmed that 1 staff and 1 client at work site allowed a client to purchase numerous items for them for three years, which poses an Immediate Health, Safety, or Personal Rights risk for the clients in care.
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The facility administrator agrees to conduct and inservice meeting with the staff, and a seperate inservice meeting with the clients. The purpose of the meeting is to advise all staff not to have clients purchase any gifts or items for them. Also for the clients not to purchase any gifts or items for staff or other clients. A copy of both inservice sign in sheets to be faxed to CCL by the POC due date.

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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:See Moua
LICENSING EVALUATOR NAME:Jacques Leffall
LICENSING EVALUATOR SIGNATURE:
DATE: 08/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/28/2024


LIC809 (FAS) - (06/04)
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