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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107202470
Report Date: 06/29/2022
Date Signed: 06/29/2022 12:44:56 PM


Document Has Been Signed on 06/29/2022 12:44 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:DIAL FOR CARE #3FACILITY NUMBER:
107202470
ADMINISTRATOR:RAMIZ ALCHIFACILITY TYPE:
740
ADDRESS:894 E. FIRTELEPHONE:
(559) 704-6467
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:6CENSUS: 1DATE:
06/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:House Manager, Briana Torres and Administrator, Ramiz AlchiTIME COMPLETED:
01:00 PM
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On 06/29/2022, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an annual inspection. Staff and residents were not present at the facility upon LPA's arrival. LPA contacted House Manager(HM), Briana Torres, via telephone. House Manager and Administrator, Ramiz Alchi arrived a short time later.

LPA conducted a facility tour with House Manager and Administrator. Facility pathways were clear from obstructions. Entrances and exits were clear. No fire clearance issues observed. Hand sanitizer dispenser observed at the front entrance. Facility staff observed to be wearing facial coverings. 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 resident medications and observed a 30 day supply. Medication was 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.

LPA is requesting the following documents be submitted to the Fresno CCL office by 07/13/2022: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance, Emergency and Disaster Plan (LIC 610E), Personnel Report (LIC500), Register of Facility Clients/Residents and Surety Bond.

CONTINUED TO 809C

SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:
DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/29/2022
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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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: DIAL FOR CARE #3
FACILITY NUMBER: 107202470
VISIT DATE: 06/29/2022
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No deficiencies issued during today's inspection.

Exit interview conducted. A copy of this report was discussed and provided to Administrator, Ramiz Alchi, whose signature on the form confirms receipt of this document.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022
LIC809 (FAS) - (06/04)
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