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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107202573
Report Date: 09/20/2021
Date Signed: 09/20/2021 01:05:39 PM

Document Has Been Signed on 09/20/2021 01:05 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:REEDLEY HOMEFACILITY NUMBER:
107202573
ADMINISTRATOR:LUPE MARTINEZFACILITY TYPE:
735
ADDRESS:3461 S. USRY AVENUETELEPHONE:
(559) 638-6640
CITY:REEDLEYSTATE: CAZIP CODE:
93654
CAPACITY: 6CENSUS: 6DATE:
09/20/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:36 AM
MET WITH:Lupe Martinez
Dale Martinez		TIME COMPLETED:
01:05 PM
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Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required Infection visit on this date. LPA allowed entrance by Licensee, Lupe Martinez Jr. and Dale Martinez stated purpose of visit.

Six (6) residents present during today's visit. Residents observed to be interacting with staff one another in a positive setting.

Facility appears clean, odor free, and at a comfortable temperature. Sufficient lighting and seating in all common areas. Resident bedrooms have all required furnishings. Linen is sufficient and in good repair. Perishable and non-perishable food supply is sufficient to meet client's needs. Resident bathrooms toured, all fixtures observed operational. LPA observed hot water temperature measured at 119 degrees F. Knives are stored and secured an inaccessible to residents. All medication observed to locked and stored in medication room.Carbon monoxide and smoke detectors observed operational during today's inspection. Fire extinguisher is present and has a service date of 6/10/2021. All chemicals are locked and secured in laundry room.

Outside of facility toured, all fire exits open freely and observed to free of obstruction. No hazards observed.

Licensee to submit the following documents to Fresno CCL office no later than 9/28/2021: Copy of Administrator Certificate, First Aid card, LIC 500, LIC 610, LIC 9020

Through LPA’s observations, documentation and record review, the required infection control practices are found to be in compliance. No deficiencies cited during today’s inspection. No deficiencies cited during visit.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2021
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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