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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 167206283
Report Date: 08/02/2022
Date Signed: 08/02/2022 11:01:29 AM

Document Has Been Signed on 08/02/2022 11:01 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:EMPLOY AMERICA #3FACILITY NUMBER:
167206283
ADMINISTRATOR:REYNOSO, DAWNFACILITY TYPE:
775
ADDRESS:307 MALL DRIVE STE 105TELEPHONE:
(559) 583-0545
CITY:HANFORDSTATE: CAZIP CODE:
93230
CAPACITY: 60CENSUS: 49DATE:
08/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:03 AM
MET WITH:Program Director Barbara RandolphTIME COMPLETED:
11:00 AM
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On 08/2/2022, Licensing Program Analyst (LPA) K.Kaur arrived unannounced to conduct an Annual Inspection - Infection Control. LPA introduced self, stated the purpose of the visit, and met Administrator Barbara Randolph.

Visitor log-in/temperature check, masks, and disinfection station was observed upon entry. Facility has one entrance/exit point. Staff observed with facial coverings. Hand sanitizer was readily available to clients and visitors. Fire extinguishers were serviced on 8/26/2021. Hand washing and other various Covid-19 related signs were observed in the common areas.

All passageways and exits were clear and free from obstruction. Facility was at a comfortable temperature and well lit. All classrooms and activity areas were clean and odor free. Bathrooms were clean and fixtures were functioning properly. LPA observed first-aid kit to be fully stocked.

Cleaning supplies were observed behind a locked door. Facility dining area toured and appeared clean. Clients bring their own lunches to program. LPA observed the following personal protective equipment in office, hand sanitizer, gloves, and masks. Staff records were reviewed for infection control training. LPA observed all facility staff wearing masks. Client files have updated emergency contact information.

No deficiencies were observed.

An exit interview was conducted. The following documents are requested and need to be submitted to Fresno
CCL by 8/9/2022. Designation of Facility Responsibility LIC308, Administrator Organization LIC309, Personnel
Report LIC500, Emergency and Disaster Plan LIC610D, and Register of Facility Clients LIC9020. Report
signed on-site by Manager and a printed copy was provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2022
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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