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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209317
Report Date: 04/09/2024
Date Signed: 04/12/2024 07:12:56 AM

Document Has Been Signed on 04/12/2024 07:12 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:LIFE SKILLS LEARNING CENTERFACILITY NUMBER:
547209317
ADMINISTRATOR/
DIRECTOR:		STUMP, KEITHFACILITY TYPE:
775
ADDRESS:2505 N SHIRKTELEPHONE:
(559) 651-8150
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY: 76CENSUS: 32DATE:
04/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Sheree Hooper, Program Manager
Keith Stump , Executive Director 		TIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On 04/09/23, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to conduct the required annual inspection. LPA was greeted by Executive Director and Program Manager , stated the purpose of the visit, and was allowed entry into the facility.

LPA toured the facility inside and out. LPA observed 32 out of 32 clients to be present and ambulatory at the facility during the inspection. LPA observed the required hand washing signs in client restrooms. LPA observed the facility to be clean and free from odor. Facility temperature measured at 69 degrees F. Disinfectants and cleaning supplies were observed to be locked in a closet and inaccessible to clients.

Emergency disaster plan and procedures are in place. Doors and passageways were observed to be free from obstruction throughout the program. Fire extinguishers were observed with a service date 11/21/23. Facility has a sprinkler system and Smoke and Carbon Monoxide detector were present in the kitchen. LPA observed a sample of staff and client files with the required form at the time of visit.

LPA requested the following updated forms to be sent to CCLD by 4/19/24: Designation of Facility Responsibility (LIC308), Administrative Organization (LIC309), Personnel Report (LIC 500), Client Roster (LIC 9020), and Emergency Disaster Plan (LIC 610D) No deficiencies cited on today's visit.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/09/2024
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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