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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507001405
Report Date: 09/16/2024
Date Signed: 09/16/2024 10:53:17 AM

Document Has Been Signed on 09/16/2024 10:53 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:CENTRAL VALLEY TRAINING CENTER, INC.FACILITY NUMBER:
507001405
ADMINISTRATOR/
DIRECTOR:		MARY VELAZQUEZFACILITY TYPE:
775
ADDRESS:1405 KANSAS AVENUE, SUITE CTELEPHONE:
(209) 522-0332
CITY:MODESTOSTATE: CAZIP CODE:
95351
CAPACITY: 126CENSUS: 115DATE:
09/16/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Courtney KegleyTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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On 9/16/24 Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct an interview with a client for which the Department received an incident report alleging abuse at a residential care facility. LPA Jensen met with staff Courtney Kegley and explained the purpose of today's visit.

LPA Jensen was advised that client 1 (C1) was not at Program on this day and that C1 was required to have an IDT meeting with the Regional Center prior to returning. LPA Jensen was advised that C1 had called the Day Program and alleged an incident of sexual abuse that had occurred in 2020. LPA Jensen reviewed facility documentation which shows that C1 called on 9/12/24 and made the allegations by telephone to staff 1 (S1). Staff 2 (S2), the Program coordinator then called C1 to obtain additional details regarding the allegations. After obtaining additional details, S2 notified the Regional Center Service Coordinator, the local Ombudsman, Licensing and Law Enforcement. It was determined that the Day Program staff took all appropriate and necessary actions.

An exit interview was conducted and a copy of this report was given.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE: DATE: 09/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2024
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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