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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107202517
Report Date: 02/16/2022
Date Signed: 02/16/2022 12:09:12 PM

Document Has Been Signed on 02/16/2022 12:09 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:V&A ASSISTED LIVINGFACILITY NUMBER:
107202517
ADMINISTRATOR:RODRIGUEZ, GEORGEFACILITY TYPE:
735
ADDRESS:11140 S. CHERRY AVETELEPHONE:
(559) 864-9873
CITY:FRESNOSTATE: CAZIP CODE:
93725
CAPACITY: 4CENSUS: 4DATE:
02/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Michael CallahanTIME COMPLETED:
12:30 PM
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Licensing Program Analysts (LPA) Katie Brown and Shawna Doucette arrived at the facility unannounced to conduct the Infection Control Inspection. LPA met with Administrator (AD) George Rodriguez and Michael Callahan. LPAs entered through the central entry point where health screening was conducted.

Infection control procedures which were observed or reviewed by LPA include: Daily symptoms screenings (for staff, residents and visitors), testing, visitation requirements, quarantine/isolation procedures, staffing, PPE and daily infection control procedures. All 4 residents are fully vaccinated and boosted.

LPAs toured the facility inside and out. Required postings as well as Covid-19 and hand washing were observed. Furniture in common and dining areas are spaced to promote distancing. Facility has designated visitation areas available. LPAs observed 30-day resident medication and PPE supply. Bathroom sinks are stocked with liquid soap and paper towels washing.



No deficiencies cited for Infection Control Annual Inspection.


A copy of this report will be emailed to Vartan Heikiman. An exit interview was conducted with AD.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Katie Brown
LICENSING EVALUATOR SIGNATURE: DATE: 02/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/16/2022
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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