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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507005586
Report Date: 01/08/2024
Date Signed: 01/08/2024 01:15:44 PM

Document Has Been Signed on 01/08/2024 01:15 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:COLE VOCATIONAL SERVICES MODESTOFACILITY NUMBER:
507005586
ADMINISTRATOR:JESSICA DELGADOFACILITY TYPE:
775
ADDRESS:544 LYELL DRTELEPHONE:
(209) 575-3100
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY: 90CENSUS: 88DATE:
01/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Jessica Delgado - Program DirectorTIME COMPLETED:
01:30 PM
NARRATIVE
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On 1/8/24 at approximately 9:45am, Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct a required 1 year annual inspection. LPA Jensen met with Jessica Delgado and explained the purpose of today's visit.

The inspection tool was used during the course of this visit. LPA Jensen toured the facility including kitchen, offices, bathrooms, common area and various activities rooms. The facility has a garden room, art room, hobby room, computer lab, music room, gym, style studio and game room. On this day the client's were engaging in a party geared toward rewarding those clients who demonstrated exemplary attendance. The temperature in the building varied from room to room with thermostat reading ranging from 64-67 degrees. The facility was determined to be sanitary and free of odor. Garbage cans in the kitchen were observed to be lacking tight fitting lids, technical assistance was provided. All paths were observed to be clear of obstruction. The fire extinguisher was last serviced May of 2023 and is in compliance. The carbon monoxide detectors were tested and found to be in good working order. The first aid kit was observed to be complete and in compliance. The Emergency Disaster Plan was posted and is current. The facility conducts fire/disaster drills more than quarterly. The medications were observed to be locked and inaccessible to clients in care. The cleaning supplies were determined to be locked and inaccessible to clients in care.

On this date the facility had 59 clients and 21 staff members. LPA Jensen reviewed 5 staff files and found them to be in compliance. LPA Jensen reviewed 5 client files and found 1 of 5 clients to have a restricted health condition. The client with the restricted health condition lacked a care plan that is in compliance California Code of Regulations (CCR) 82092.2, technical assistance was provided. 5 of client files contained the required medical assessments, tuberculosis verifications, admission agreements and needs and service plans.

Continued on LIC 809C...
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE: DATE: 01/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/08/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: COLE VOCATIONAL SERVICES MODESTO
FACILITY NUMBER: 507005586
VISIT DATE: 01/08/2024
NARRATIVE
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LPA Jensen conducted client and staff interviews. LPA Jensen reviewed water temperature logs for this date and determined that 4 of 6 bathrooms had water temperature readings that were not in compliance as a result of measuring below 105 degrees.

LPA Jensen observed 4 ceiling tiles in the hallway that appeared to be damaged as a result of water damage.

Deficiencies are being cited from the California Code of Regulations (CCR) Title 22, Division 6. Failure to correct deficiencies may result in the assessment of civil penalties.

An exit interview was conducted and a copy of this report, a confidential names list and appeal rights were given.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/08/2024 01:15 PM - It Cannot Be Edited


Created By: Maja Jensen On 01/08/2024 at 12:42 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: COLE VOCATIONAL SERVICES MODESTO
FACILITY NUMBER: 507005586

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82087(a)
Buildings and Grounds
(a) The program site shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA Jensen's observation of 4 ceiling tiles in disrepair, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/15/2024
Plan of Correction
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Licensee or facility staff will email Lessor's plan to replace the ceiling tiles and an Lessor will provide an attestation that the roof is not leaking in the area in question.
Type B
Section Cited
CCR
82088(a)(1)
Fixtures, Furniture, Equipment, and Supplies
(1) The licensee shall maintain the temperature in rooms that clients occupy between a minimum of 68 degrees F (20 degrees C) and a maximum of 85 degrees F (30 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA Jensen's observation of the facility thermostats, the licensee did not comply with the section cited above in 4 out of 4 thermostats checked which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/15/2024
Plan of Correction
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Licensee or facility staff will begin submitting a log of temperature readings for one week commencing on the POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lisa Rios
LICENSING EVALUATOR NAME:Maja Jensen
LICENSING EVALUATOR SIGNATURE:
DATE: 01/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/08/2024


LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 01/08/2024 01:15 PM - It Cannot Be Edited


Created By: Maja Jensen On 01/08/2024 at 12:42 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: COLE VOCATIONAL SERVICES MODESTO
FACILITY NUMBER: 507005586

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA Jensen's review of the water temperature lof for 1/8/24, the licensee did not comply with the section cited above in 4 out of 6 bathrooms which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/15/2024
Plan of Correction
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Licensee or facility staff will begin submitting a log of temperature readings for one week commencing on the POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lisa Rios
LICENSING EVALUATOR NAME:Maja Jensen
LICENSING EVALUATOR SIGNATURE:
DATE: 01/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/08/2024


LIC809 (FAS) - (06/04)
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