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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547203972
Report Date: 03/19/2024
Date Signed: 03/19/2024 11:26:41 AM

Document Has Been Signed on 03/19/2024 11:26 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:DEVRIES, LINDSEYFACILITY TYPE:
775
ADDRESS:9838 W. GROVE AVETELEPHONE:
(559) 651-2844
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY: 75CENSUS: 33DATE:
03/19/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Program Director, Lindsey Devries TIME COMPLETED:
11:30 AM
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On 03/19/24, Licensing Program Analysts (LPAs) L. Salazar and S.Doucette arrived at the facility unannounced to conduct a case management visit based on an incident that was reported regarding a client who lives in licensed home. LPAs stated the purpose of the visit and were allowed entry into the facility. LPAs met with Program Director (PD) to discuss incident that occurred on 03/11/24.

LPAs obtained staff schedule and interviewed Staff S1 who stated they observed Client C1's pureed lunch to have larger chunks of carrots in the tupperware when C1 arrived to program. S1 reported the incident to Program Director who contacted C1's responsible party. LPAs interviewed Staff S2 and Staff S3 that were present at the facility, however, staff did not observe lunch as they were working in another classroom or outside.

LPA obtained facility logs. No Deficiencies cited on today's visit.




SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 03/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2024
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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