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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507001405
Report Date: 11/07/2024
Date Signed: 11/07/2024 12:07:33 PM

Document Has Been Signed on 11/07/2024 12:07 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
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: 144DATE:
11/07/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Interim Program Director Courtney KegleyTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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On 11/07/24, Licensing Program Analyst Renee Campbell conducted an consultation regarding reporting requirements. LPA Campbell met with Interim Program Director Courtney Kegley and discussed the increase in incident report calls regarding peer aggression in the day program.

The Interim Program Director (IPD).Courtney Kegley stated that staff had been told to call in any incidents to their assigned LPA within two hours, regardless of severity. LPA Campbell provided clarification via email and in person that only incidents of severe physical injury, possible abuse, abandonment, etc. should be reported within 2 hours as required in Welfare and Institutions Code section 15630(b)(1). In which case, a SOC 341 should also be submitted for cross reporting.

LPA Campbell reviewed regulations in Title 22, Division 6, Chapter 3, Article 6 82061 for reporting requirements, discussed their implications and provided a link to Day Program regulations to the Interim Program Director via email.

LPA Campbell requested that only severe incidents of abuse or physical injury should be submitted within two hours and and that non-severe incidents should be submitted at the beginning or end of the day.


At this time, no deficiencies have been cited.

An exit interview was conducted and a copy of this report were provided.


SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2024
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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