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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107202470
Report Date: 06/22/2021
Date Signed: 06/22/2021 11:18:19 AM

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:DIAL FOR CARE #3FACILITY NUMBER:
107202470
ADMINISTRATOR:EDWARDS, LAURAFACILITY TYPE:
740
ADDRESS:894 E. FIRTELEPHONE:
(559) 704-6467
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:6CENSUS: 2DATE:
06/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:34 AM
MET WITH: House Manager, Tessa NunezTIME COMPLETED:
11:15 AM
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On 06/22/2021, Licensing Program Analyst (LPA) Walton arrived unannounced at the above facility to conduct an Annual Inspection. LPA contacted House Manager (HM) Tessa Nunez, via telephone. House Manager arrived a short time later. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility. Facility has one entry/exit point. Visitor log-in/temperature check was observed upon entry to the facility. Staff observed to be wearing facial coverings.

There is one resident present during this inspection. Resident observed to be watching TV.
LPA conducted a facility tour with HM. Facility pathways were clear from obstructions. Entrances and exits were clear. No fire clearance issues observed. Hand sanitizer dispenser observed at the front entrance. Social distancing maintained in common and dining areas. LPA observed signs promoting social distancing, cough/sneeze etiquette, and hand-washing. Bathrooms observed to be stocked with paper towels and liquid soap. Bedrooms are single occupant.

LPA checked residents' medication for a 30 day supply. Medications observed to be locked and secure. Food supply checked. LPA observed a 7 day supply of non-perishable items and a 2-day supply of perishable items. Facility has at least a 30 day supply of cleaning supplies and PPE. Staff records reviewed for good health and infection control training. Resident records observed to have updated emergency contact information.

No deficiencies observed during this inspection.

Exit interview conducted. As a COVID-19 precautionary measure, a copy of this report will be provided via email and an electronic read receipt confirms receiving this document. HM was informed to select yes when prompted to send read receipt. Facility Representative signature on file.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2021
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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