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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390308140
Report Date: 06/13/2023
Date Signed: 06/13/2023 03:39:37 PM

Document Has Been Signed on 06/13/2023 03:39 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:CENTRAL VALLEY TRAINING CENTER, INC.FACILITY NUMBER:
390308140
ADMINISTRATOR:RAYMOND NYLENFACILITY TYPE:
775
ADDRESS:7603 MURRAY DRIVETELEPHONE:
(209) 951-1504
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY: 90CENSUS: 79DATE:
06/13/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:03 PM
MET WITH:Michael CarrollTIME COMPLETED:
03:45 PM
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On 6-13-23 at 2:03pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a case management visit regarding a resident to resident altercation which occurred on 5-19-23. LPA met with Program Director (PD) Michael Carroll and explained the purpose of the visit. LPA reviewed incident reports with PD during case management. Based on interview and record review, it was determined that R1 grabbed R2 on the arm in an aggressive manor. It was further determined that facility staff intervened and successfully separated R1 and R2 to prevent further escalation. A follow up meeting was held with facility on 6-1-23 to discuss the above event which included additional strategies put in place in regards to R1's aggression. Individualized Program Plans for R1 and R2 are updated to reflect above event including interventions. Facility reported above event to licensing department, local law enforcement, and ombudsman per regulatory requirements.

Based on this case management, no deficiencies are cited. An exit interview was conducted with program director Michael Carroll and a copy of this report was left with Michael.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2023
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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