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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507005586
Report Date: 01/23/2025
Date Signed: 01/23/2025 12:12:43 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 01/23/2025 12:12 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/
DIRECTOR:		JESSICA DELGADOFACILITY TYPE:
775
ADDRESS:544 LYELL DRTELEPHONE:
(209) 575-3100
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY: 90CENSUS: 66DATE:
01/23/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:53 AM
MET WITH:Jessica DelgadoTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to conduct an annual inspection. LPA met with Jessica D, Program Director and stated the purpose of todays visit. LPA was allowed entry into the facility that is licensed to serve a total capacity of 90 clients. LPA observed clients during this visit.

LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to clients. During the tour LPA observed unlocked toxins in an open office on the desk unattended and accessible to residents in care. The facility has heating equipment such as microwave, and refrigeration that was found to be in working condition and readily available for client use. The facility conducts fire and disaster drills monthly and logged the last drill on 11/2024 .

The temperature inside the facility measured at 70 *F which is within the required range of 68-85*F. The hot water temperature was measured at 109.0 *F which is within the required range of 105-120*F. LPA observed a pull alarm system, fire extinguisher(s), smoke and carbon monoxide detectors, central heating and air in the facility.

LPA observed medication for R1 stored in R1's backpack not locked and accessible to clients. The first aid kit contained the required items. LPA reviewed 6 staff and 8 consumer files during this visit.

Per the California Code of Regulations, Title 22, Division 6, Chapter 6, violations were cited during this visit.

Exit interview held, copy of report given.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2025
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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Document Has Been Signed on 01/23/2025 12:12 PM - It Cannot Be Edited


Created By: Albert Johnson On 01/23/2025 at 11:38 AM
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: 01/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/24/2025
Section Cited
CCR
82075(l)(1)

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(l) The following requirements shall apply to medications which are centrally stored: (1)Medication shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.
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The Program Director shall submit a plan to CCL on how the facility will store and dispense medications according to Title 22, regulation 82075 by POC date 1/24/25
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This requirement was not met as evidenced by LPA observed medication for R1 stored in R1's backpack not locked and accessible to clients. This is an immediate safety risk.
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Email to LPA the plan.
Type A
01/24/2025
Section Cited
CCR82087(a)(3)

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(3) Disinfectants, cleaning solutions, poisons, and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.
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The Program Director shall submit a plan to CCL on how the facility will store cleaning supplies according to Title 22, regulation 82087. By POC date 1/24/25
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During the tour LPA observed unlocked toxins in an open office on the desk unattended and accessible to residents in care.

This is an immediate safety risk.
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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:Albert Johnson
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2025


LIC809 (FAS) - (06/04)
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