<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 390308140
Report Date: 08/09/2023
Date Signed: 08/09/2023 04:09:48 PM

Document Has Been Signed on 08/09/2023 04:09 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: 82DATE:
08/09/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Michael CarrollTIME COMPLETED:
04:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 8-9-23 at 2:15pm, Licensing Program Analysts (LPAs) Michael Bilger and Arvin Villanueva arrived unannounced to conduct a case management visit regarding resident to resident altercations and a previous incident regarding client possession of cannabis edibles. LPAs met with Program Director (PD) Michael Carroll and explained the purpose of the visit. During today's case management, LPAs reviewed incident reports dated 7-14-23 an 7-27-23 and interviewed PD.

Based on incident report dated 7-14-23, resident1 (R1) was witnessed by day program staff to be licking a container which was in R1's possession. Staff1 (S1) inquired what R1 had in possession and R1 stated: "just my cannabis." Day program staff witnessed a container marked "cannabis" Based on interview, it was determined that the items in the container was candy placed by R1's family member who marked the container "cannabis" as R1 has a history of desiring various drugs, and R1's family member used the marked container as an attempt to redirect R1 from desiring and potentially seeking drugs. Incident was reported to Department and other entities per regulatory requirements.

Based on incident reports dated 7-27-23, R2 and R3 engaged in a resident to resident altercation. Incident reports state R2 charged towards R3 and slapped R3 in the face causing redness. Day program staff provided general first aid including ice pack. Incident was reported to Licensing department, ombudsman, police department and other entities per regulatory requirements. It was revealed through interview, that R1 has engaged in multiple resident to resident altercations which have been reported accordingly. Interview also revealed additional resident to resident altercations within the last 30 days.

LPAs discussed with program director possible solutions to help mitigate resident to resident altercations. At this time program director as agreed to the following: (1)Licensee or designee will ensure continued additional staff training on various mental health topics including but not limited to: De-escalation of behaviors and peer conflicts, identifying triggers for various behaviors, safe intervention techniques regarding aggression and anger. {Cont. on 809C}.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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
VISIT DATE: 08/09/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
(2) Ensure continued daily rounds conducted in classrooms to help instructors pro-actively identify potential behavior outbursts by clients., (3) Continue weekly staff meetings with emphasis on currently challenging clients and pro-active interventions as necessary. (4) Program Director will ensure documentation of above items.

No citations issued today as a result of this case management. An exit interview was conducted with Michael Carroll and a copy of this report was provided to Michael.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2