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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547203972
Report Date: 11/13/2023
Date Signed: 11/15/2023 09:11:02 AM

Document Has Been Signed on 11/15/2023 09:11 AM - 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, 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:
11/13/2023
TYPE OF VISIT:CollateralANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Lindsey Devries, Administrator
Kelly Reyes, Program Coordinator 		TIME COMPLETED:
01:53 PM
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On 11/13/23, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to conduct a collateral visit based of a self reported incident at People's Care Chavez. LPA was greeted by receptionist, stated the purpose of the visit and asked to speak to Administrator on record, Lindsey Devries.

LPA interviewed Administrator, Staff S1 and Resident R1. LPA obtained facility incident reports and information from Resident R1's file.

Visit concluded. No deficiencies cited on today's visit.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 11/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/13/2023
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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