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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547204112
Report Date: 03/20/2024
Date Signed: 03/20/2024 02:40:33 PM

Document Has Been Signed on 03/20/2024 02:40 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: 66DATE:
03/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:27 AM
MET WITH:Administrator Thea JohnsonTIME COMPLETED:
02:45 PM
NARRATIVE
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On 3/20/2024, Licensing Program Analyst (LPA) K. Kaur arrived unannounced to conduct an annual inspection. LPA completed a tour of the facility with staff. Staff contacted Administrator Thea Johnson who arrived a short while later.

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. At 11:26 AM LPA observed scissors in unlocked drawer in the conference room 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 toured the library for quiet space. Computer room, Arts room toured. Carbon monoxide detectors installed and operational. Fire extinguishers serviced on 11/17/2023. LPA toured the patio area where clients have access to gardening activities. LPA observed sufficient seating under a covered area. Client’s records contained signed Admission Agreement, Personal Rights, and current Physician's Report and ID Documentation. Staff files were reviewed for good health. It was verified that current staff on duty are CPR certified. Documentation review of Fire department annual inspection. Last Fire Drill conducted on 1/20/2024.



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

The following documents are requested and need to be submitted to Fresno CCL office by 3/27/2024: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Emergency and Disaster Plan (LIC610D), Personnel Report (LIC500), Register of Facility Clients/Residents LIC9020.

An exit interview was conducted with the Administrator. Report signed on-site; a copy of this report, 809D with appeal rights was provided via email due to technical difficulties.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2024
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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Document Has Been Signed on 03/20/2024 02:40 PM - It Cannot Be Edited


Created By: Kamaldeep Kaur On 03/20/2024 at 02:25 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: 03/20/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
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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Based on observation, the licensee did not comply with the section cited above in 1 out of 1; LPA observed scissors in unlocked drawer in the conference room cabinet which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/21/2024
Plan of Correction
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Staff removed scissors and placed them in locked area. Administrator to submit in service training with all regarding placed chemicals and sharp items behind locked area.
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: 03/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/20/2024


LIC809 (FAS) - (06/04)
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