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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 240407470
Report Date: 02/24/2022
Date Signed: 02/25/2022 08:03:44 AM

Document Has Been Signed on 02/25/2022 08:03 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 CENTER IIFACILITY NUMBER:
240407470
ADMINISTRATOR:KALEMBER, SAMUELFACILITY TYPE:
775
ADDRESS:703 "I" STREETTELEPHONE:
(209) 826-8118
CITY:LOS BANOSSTATE: CAZIP CODE:
93635
CAPACITY: 60CENSUS: 0DATE:
02/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Irma Torres - Program DirectorTIME COMPLETED:
02:00 PM
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Licensing Program Analyst(LPA) D. Ayers arrived unannounced to conduct a Required Annual inspection. LPA met with Program Director Irma Torres and announced the purpose of the inspection.

LPA toured the facility inside and outside. The facility was adequately lit and at a comfortable temperature. There was adequate seating and space for all clients. All exits and passageways were clear and free from obstruction. Facility fire extinguishers were serviced and fully charges. Client bathrooms were clean, odor free, and all fixtures were functioning properly. Foodstuffs appeared to be properly stored. Facility disaster plan was reviewed. LPA and Program Director reviewed infection control guidelines and best practices. Clients were currently receiving services remotely. No deficiencies were cited during the inspection. A copy of the report was provided and exit interview conducted.
SUPERVISORS NAME: Andy Xiong
LICENSING EVALUATOR NAME: David Ayers
LICENSING EVALUATOR SIGNATURE: DATE: 02/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/24/2022
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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