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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547204112
Report Date: 02/06/2023
Date Signed: 02/06/2023 02:48:54 PM

Document Has Been Signed on 02/06/2023 02:48 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:SOCIAL VOCATIONAL SERVICES, VISALIA #2FACILITY NUMBER:
547204112
ADMINISTRATOR:THEADOSIA JOHNSONFACILITY TYPE:
775
ADDRESS:3140 WEST CALDWELL AVENUETELEPHONE:
(559) 735-0938
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY: 75CENSUS: 51DATE:
02/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Administrator Thea Johnson TIME COMPLETED:
02:48 PM
NARRATIVE
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On 2/06/2023, Licensing Program Analyst (LPA) K. Kaur arrived unannounced to conduct an Annual Inspection - Infection Control. LPA met Thea Johnson, Administrator. LPA completed a tour of the facility with administrator. Visitor log-in/temperature check was observed upon entry. Hand sanitizer was readily available to clients and visitors.

The Day Program has eight classrooms separated into cohorts. Facility is maintained at a comfortable temperature. LPA observed adequate seating and lighting throughout the facility. No passageway obstructions or fire hazards were observed inside or outside. Client restrooms were toured, observed to be clean, and operational. LPA observed hand washing postings by all sinks. LPA observed social distancing and cough etiquette postings in facility. At 1:48 PM LPA observed Facility Kitchen to have sharp items in an unlocked cabinet. Facility dining area was toured. Clients bring their own lunches to program. Locked cubbies were observed in the kitchen. This Day Program does not dispense medications. Cleaning supplies were observed behind locked door; in a storage room. LPA observed 30-day PPE supply. A sample of client files were also reviewed to have updated emergency contact information. Staff files have current 1st Aid and infection control training.



Deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22,
Division 6.

An exit interview was conducted. The following documents are requested and need to be submitted to Fresno


CCL by 2/13/23. Designation of Facility Responsibility LIC308, Administrator Organization LIC309,
Personnel Report LIC500, Emergency and Disaster Plan LIC610D, and Register of Facility Clients LIC9020.

Report signed on-site by Administrator; a printed copy was provided with appeal rights.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2023
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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Document Has Been Signed on 02/06/2023 02:48 PM - It Cannot Be Edited


Created By: Kamaldeep Kaur On 02/06/2023 at 02:34 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
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: SOCIAL VOCATIONAL SERVICES, VISALIA #2
FACILITY NUMBER: 547204112

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80087(g)

80087 Buildings and Grounds
(g) Disinfectants, cleaning solutions, poisons, firearms and other items that 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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Based on observation, the licensee did not comply with the section cited above in 1 out of 1, when LPA observed sharp items in unlocked drawer in the kitchen. Which poses an immediate health, safety or personal rights risk to persons in care..
POC Due Date: 02/07/2023
Plan of Correction
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Administrator removed sharp items and placed inaccessible to clients. Staff will be reminded to not leave sharps accessible to
clients and install a cabinet lock in kitchen for future storage.
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:See Moua
LICENSING EVALUATOR NAME:Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE:
DATE: 02/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/06/2023


LIC809 (FAS) - (06/04)
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