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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547203972
Report Date: 05/01/2023
Date Signed: 06/09/2023 03:04:32 PM

Document Has Been Signed on 06/09/2023 03:04 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
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:CENTRAL VALLEY TRAINING CENTERFACILITY NUMBER:
547203972
ADMINISTRATOR:LOWES, MARIAFACILITY TYPE:
775
ADDRESS:9838 W. GROVE AVETELEPHONE:
(559) 651-2844
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY: 75CENSUS: 27DATE:
05/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:27 AM
MET WITH:Maria Lowes, AdministratorTIME COMPLETED:
03:10 PM
NARRATIVE
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This report was amended.

On 5/1/23 at 8:27 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct an Annual inspection. LPA explained reason for inspection and met with Administrator (ADM/Program Director) Maria Lowes.

LPA toured the inside and outside of the facility. No obstructions observed. Facility set at comfortable temperature. Fire alarm pull station observed. Fire extinguishers last serviced 3/23/23. Carbon monoxide detector tested and operational. Hot water measured 116.3 degrees F in RR#5 (restroom) and 114.3 degrees F in RR#1. Lockers observed available for all clients. Hand washing signs observed at bathroom sinks and waste bins observed with tight-fitting lid. Chemicals and cleaning solutions observed in locked storage room. Outdoor activity spaces observed with seating, shade, and fence enclosing the area. Food is not served by the facility but microwaves are available for use in a locked storage unit in each classroom and in the staff area. First aid kit observed complete. Centrally stored medication observed designated to storage unit in Program Coordinator office area. Client and staff files reviewed.

The following deficiency is being cited:
1. All five bathrooms observed with a black substance around the base of each toilet and its caulking; toilets, soap dispensers, sinks and faucets, and complete wall surround paneling all observed unclean with dust and stains; and floors observed unmopped, with dirt/dust in corners of the flooring.

Deficiency is being cited based on LPA observations and interview conducted in accordance with the California Code of Regulations, Title 22, see LIC809D.



***Continue on LIC809-C.***
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE: DATE: 06/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/09/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
Document is an Amendment of Original Document on 06/09/2023 02:35 PM


Created By: Malia Thao On 05/01/2023 at 01:56 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: CENTRAL VALLEY TRAINING CENTER
FACILITY NUMBER: 547203972

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/01/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Request Denied
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 observation and interview, the licensee did not comply with the section cited above. All five bathrooms observed with a black substance around the base of each toilet and its caulking; toilets, soap dispensers, sinks and faucets, and complete wall surround paneling all observed unclean with dust and stains; and floors observed unmopped, with dirt/dust in corners of the flooring, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/22/2023
Plan of Correction
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Administrator will ensure all toilets, soap dispensers, sinks and faucets, complete wall surround paneling, and floors in all five bathrooms are cleaned, and all five toilet bases are re-caulked by POC due date. LPA will return for a POC visit.
Deficiency Dismissed
Type B
Section Cited
CCR
82087(a)(3)
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. (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.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Citation Amended
POC Due Date: 05/01/2023
Plan of Correction
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Citation Amended
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:Melinda Hoffmann
LICENSING EVALUATOR NAME:Malia Thao
LICENSING EVALUATOR SIGNATURE:
DATE: 06/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/09/2023


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
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: CENTRAL VALLEY TRAINING CENTER
FACILITY NUMBER: 547203972
VISIT DATE: 05/01/2023
NARRATIVE
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This report was amended.

Continued from LIC809.

The following updated forms are to be submitted to CCL within two weeks:

LIC500, LIC308, LIC9020, LIC610D (new revision)

An exit interview was conducted and Plans of Corrections were reviewed and developed with the Administrator. Due to technical difficulties, a copy of this report and appeal rights were emailed to Administrator Maria Lowes with a "read receipt".

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023
LIC809 (FAS) - (06/04)
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