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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 240403819
Report Date: 12/18/2023
Date Signed: 12/18/2023 03:07:10 PM

Document Has Been Signed on 12/18/2023 03:07 PM - 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 ASC, 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: 92DATE:
12/18/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Program Director, Katherine Coleman TIME COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Sarah Hurt arrived at the facility unannounced on 12/18/2023 at 03:00 p.m. to conduct a Case Management visit. LPA met with facility Program Director, Katherine Coleman and explained the purpose for today’s visit.

Client 1's Physician Report needs to be updated along with their Needs and Services Plan. Client 1's diagnosis on their Physicians Report is not complete,and Needs and Services Plan not updated to reflect recent need for incontinent care.

The following Deficiencies are being cited Per Title 22 Regulations.

Exit interview conducted with Program Director, Katherine Coleman , and a copy of this report along with Appeals rights provided.

SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE: DATE: 12/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/18/2023
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 12/18/2023 03:07 PM - It Cannot Be Edited


Created By: Sarah Hurt On 12/18/2023 at 02:54 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: KINGS VIEW WORK EXPERIENCE CENTER
FACILITY NUMBER: 240403819

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/02/2024
Section Cited
CCR
87878

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82068.2 Needs and Services Plan (a) Prior to admission, the licensee shall determine whether the day program can meet the prospective client's service needs.(d) If the client has an existing needs appraisal or individual program plan (IPP) completed by a placement agency, or a consultant for the placement agency, the Department may consider the plan to meet the requirements of this section provided that:
(1) The needs appraisal or IPP is not more than one year old.(2) The licensee and the placement agency agree that the client's physical, mental and emotional status has not significantly changed since
the assessment. The following requiremtent has not been met as evidenced by:
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Executive director will send current updated IPP to LPA for Client 1 by POC date of 01/02/2024.
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Client 1's IPP is outdated, and does not mention his need for incontinent care, which poses a potential, health, safety, or personal rights risk to residents in care.
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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:Brenda Chan
LICENSING EVALUATOR NAME:Sarah Hurt
LICENSING EVALUATOR SIGNATURE:
DATE: 12/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/18/2023


LIC809 (FAS) - (06/04)
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