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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547204156
Report Date: 06/14/2024
Date Signed: 06/14/2024 12:17:02 PM

Document Has Been Signed on 06/14/2024 12:17 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:LINDSAY SERVICE CENTERFACILITY NUMBER:
547204156
ADMINISTRATOR/
DIRECTOR:		ESMERALDA GAITHERFACILITY TYPE:
775
ADDRESS:911 PARKSIDE AVENUETELEPHONE:
(559) 562-2713
CITY:LINDSAYSTATE: CAZIP CODE:
93247
CAPACITY: 45CENSUS: 13DATE:
06/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:18 AM
MET WITH:Program Coordinator, Stephanie Arredondo and Administrator, Esmeralda GaitherTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
NARRATIVE
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On 06/14/2024, Licensing Program Analyst (LPA) Walton, arrived unannounced to conduct an Annual Required Inspection. LPA introduced self and stated that purpose of the visit. LPA met with Program Coordinator, Stephanie Arredondo and Administrator, Esmeralda Gaither.

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. Hot water measured at 108.9 degrees F. Clients provide their own meals. Facility does not administer medications to clients. LPA observed chemicals to be locked in a cabinet in the facility. Fire extinguishers were last serviced on 09/12/2023.



Outside of facility was toured. There are no bodies of water on the premises. Facility records reviewed. LPA reviewed a sample of client records and found that 5 out of 5 clients did not have an admission agreement on file. Staff records were reviewed and found to be complete.

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

Exit interview conducted and a plan of correction was reviewed and developed. A copy of this report and appeal rights were discussed and provided to Administrator, Esmeralda Gaither, whose signature on this form confirms receipt of this document.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 06/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/14/2024
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 06/14/2024 12:17 PM - It Cannot Be Edited


Created By: Alexandria Walton On 06/14/2024 at 12:04 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: LINDSAY SERVICE CENTER
FACILITY NUMBER: 547204156

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/14/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82068(a)
Admission Agreements
(a) The licensee shall complete and maintain an individual written admission agreement with each client and the client's authorized representative, if any.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above when 5 out of 5 clients did not have an admission agreement on file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/21/2024
Plan of Correction
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Licensee agrees to submit a copy of the admission agreement for 5 out of 5 residents to the Fresno CCL office by the POC due date.
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: 06/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2024


LIC809 (FAS) - (06/04)
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