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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 167206283
Report Date: 01/27/2025
Date Signed: 01/27/2025 10:19:13 AM

Document Has Been Signed on 01/27/2025 10:19 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:EMPLOY AMERICA #3FACILITY NUMBER:
167206283
ADMINISTRATOR/
DIRECTOR:		DONALDSON, NICHOLASFACILITY TYPE:
775
ADDRESS:307 MALL DRIVE STE 105TELEPHONE:
(559) 583-0545
CITY:HANFORDSTATE: CAZIP CODE:
93230
CAPACITY: 60CENSUS: 52DATE:
01/27/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:Program Director: Nicholas DonaldsonTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
NARRATIVE
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On 1/27/24, Licensing Program Analyst (LPA) J. Leffall conducted a case management visit to follow up and confirm details of an incident report that was received by the Department. The incident occurred on 1/10/25, in which C1’s personal rights were violated on a community outing, C1 informed Staff (S1) and (S2), needed to use the bathroom. C1 was not taken to the bathroom in time by S1 and S2 resulting soiled clothing. LPA met with Program Director (PD) Nicholas Donaldson.

Per LIC-624 the facility completed a termination of S1 and S2 resigned employment. The document was submitted to CCLD.

A citation is issued on the attached 809-D regarding client’s Personal Rights.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Jacques Leffall
LICENSING EVALUATOR SIGNATURE: DATE: 01/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/27/2025
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 01/27/2025 11:55 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 01/27/2025 11:54 AM


Created By: Jacques Leffall On 01/27/2025 at 09:51 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: EMPLOY AMERICA #3
FACILITY NUMBER: 167206283

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/27/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/27/2025
Section Cited
CCR
82072(a)(3)

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(a) Each client shall have personal rights which include, but are not limited to, the following:

(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including but not limited to: interference with the daily living functions, including eating, sleeping, or toileting; or withholding of shelter, clothing, medication, or aids to physical functioning.

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Licensee agrees to complete thorough investigation. Safety training will be completed with staff. After findings of investigation immediate action will be taken which will result in suspension or even termination.
**POC cleared during visit**


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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: 01/27/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/27/2025


LIC809 (FAS) - (06/04)
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