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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209317
Report Date: 03/20/2023
Date Signed: 03/20/2023 05:31:57 PM

Document Has Been Signed on 03/20/2023 05:31 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:LIFE SKILLS LEARNING CENTERFACILITY NUMBER:
547209317
ADMINISTRATOR:STUMP, KEITHFACILITY TYPE:
775
ADDRESS:2505 N SHIRKTELEPHONE:
(559) 651-8150
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY: 76CENSUS: 0DATE:
03/20/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Mark Michaelian Director of Program Services (DPS); Sheree Hooper LS Program Manager (PM); TIME COMPLETED:
05:45 PM
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An Pre-Licensing visit was conducted on the time & date by Licensing Program Manager (LPA) K. McClurg. LPA met with Mark Michaelian Director of Program Services (DPS) & Sheree Hooper LS Program Manager (PM);

Facility phone: (559) 651-8150. Physical plant toured. Regulations reviewed. Facility is clean & in good repair. Interior & exterior passageways free of obstructions. Items that could pose a danger, such as disinfectants, cleaning solutions, etc., are inaccessible. Sufficient lighting & furnishings in activity rooms. Facility has separate quiet/sick room. Locked centralized storage area for medications. First aid kit complete. Hot water tested & measured at 109 degrees F for restrooms & 120 degrees F for kitchen. Physical plant is consistent with the facility sketch/floor plan. Fire extinguisher service date: 10/07/2022. Smoke & carbon monoxide detectors tested & determined to be operational.

A Component III was conducted.

Pre-Licensing is complete and this facility has no deficiencies

Exit interview conducted with DPS & PM. Report provided at time of visit.






SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE: DATE: 03/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2023
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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