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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 240403819
Report Date: 09/30/2022
Date Signed: 09/30/2022 10:40:05 AM

Document Has Been Signed on 09/30/2022 10:40 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:KINGS VIEW WORK EXPERIENCE CENTERFACILITY NUMBER:
240403819
ADMINISTRATOR:KALEMBER, SAMUELFACILITY TYPE:
775
ADDRESS:100 AIRPARK ROADTELEPHONE:
(209) 357-0321
CITY:ATWATERSTATE: CAZIP CODE:
95301
CAPACITY: 200CENSUS: 122DATE:
09/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:09 AM
MET WITH:Program Coordinator, Katherine ColemanTIME COMPLETED:
10:54 AM
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On 09/30/2022, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an annual inspection. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with Program Coordinator, Katherine Coleman. Facility has on central entry and exit. Facility has implemented a sign in policy for visitors.

LPA conducted a facility tour with PC. All pathways, entrances, and exits were clear of obstructions. No fire clearance issues observed during this inspection. Client temperatures are documented daily. LPA observed signs promoting social distancing, cough/sneeze etiquette, and hand-washing throughout the facility. Facility bathrooms are stocked with liquid soap and paper towels. Hand-sanitizer dispensers were observed in the hallways and on the tables in the classrooms. Clients are in cohorts of 4-8. Clients are encouraged to wear facial coverings. Clients provide their own lunch. LPA observed an adequate supply of PPE and cleaning supplies.

LPA reviewed a sample of clients records and did not observe updated emergency contact information. Personnel files were reviewed for good health.

LPA is requesting the following documents be submitted to the Fresno CCL Office by 10/14/2022: Designation of Facility Responsibility, Administrative Organization, Emergency and Disaster Plan, Personnel Report, and Client Roster.



No deficiencies issued during today's inspection.

Exit interview conducted. A copy of this report was discussed and provided to Program Coordinator, Katherine Coleman, whose signature on this form confirms receipt of this document.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 09/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2022
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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