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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547204156
Report Date: 06/28/2023
Date Signed: 07/13/2023 11:45:21 AM

Document Has Been Signed on 07/13/2023 11:45 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:LINDSAY SERVICE CENTERFACILITY NUMBER:
547204156
ADMINISTRATOR:ESMERALDA GAITHERFACILITY TYPE:
775
ADDRESS:911 PARKSIDE AVENUETELEPHONE:
(559) 562-2713
CITY:LINDSAYSTATE: CAZIP CODE:
93247
CAPACITY: 45CENSUS: 11DATE:
06/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Client Program Coordinator, Bethany Shoemake.
TIME COMPLETED:
12:11 PM
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This is an amended report. On 06/28/2023, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an annual inspection. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. Administrator, Esmeralda Gaither, was not available during today's visit. LPA met with Client Program Coordinator, Bethany Shoemake.

LPA toured inside and outside of the facility. No fire hazards or passageway obstructions were observed. LPA observed sufficient seating and adequate lighting throughout the facility. LPA toured the client restrooms which appeared clean and operational. Clients provide their own meals. LPA observed chemicals to be locked in a cabinet in the facility. Facility does not administer medications to clients. Fire extinguishers were last serviced on 06/05/2023.

Outside of facility was toured. There are no bodies of water on the premises. LPA will return at a later date to review client and staff records.

Exit interview conducted. A copy of this report was discussed and provided to Client Program Coordinator, Bethany Shoemake, whose signature on this form confirms receipt of this document.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2023
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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Document Has Been Signed on 07/13/2023 11:46 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 07/13/2023 11:36 AM


Created By: Alexandria Walton On 06/28/2023 at 12:41 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: LINDSAY SERVICE CENTER
FACILITY NUMBER: 547204156

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/28/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Deficient Practice Statement
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Amended
POC Due Date:
Plan of Correction
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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:Melinda Hoffmann
LICENSING EVALUATOR NAME:Alexandria Walton
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2023


LIC809 (FAS) - (06/04)
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