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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507005586
Report Date: 01/03/2022
Date Signed: 05/24/2022 02:29:23 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 05/24/2022 02:29 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:COLE VOCATIONAL SERVICES MODESTOFACILITY NUMBER:
507005586
ADMINISTRATOR:MADSEN, TAMARAFACILITY TYPE:
775
ADDRESS:544 LYELL DRTELEPHONE:
(209) 575-3100
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY: 90CENSUS: 97DATE:
01/03/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Program Manager, Lisa Bartley TIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with facility Program Director Lisa Bartley. There are currently 97 who receive services at the program. LPA inspected the interior and the exterior of the facility including the common spaces, activity rooms, bathrooms, medication storage, and outdoor areas. Activity rooms, and common areas were clean and in good repair. There is a locked storage for medications.

Fire extinguisher is within the safety regulation period. Smoke alarms were tested and are operational. The home has a carbon monoxide detector and performs disaster drills as required. Water temperature was tested at 109 degrees. First Aid kit is on site and complete. Toxins and cleaning supplies are locked and inaccessible.

There were no deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22.

LPA requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing.

Exit interview conducted with Lisa Bartley and copy of report left at facility
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE: DATE: 01/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/03/2022
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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