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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107203254
Report Date: 06/25/2021
Date Signed: 06/25/2021 03:15:38 PM

Document Has Been Signed on 06/25/2021 03:15 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:FARROLL HOMEFACILITY NUMBER:
107203254
ADMINISTRATOR:COOK, PENNYFACILITY TYPE:
735
ADDRESS:1862 FLORENCE AVE.TELEPHONE:
(559) 876-9046
CITY:SANGERSTATE: CAZIP CODE:
93657
CAPACITY: 6CENSUS: 4DATE:
06/25/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Licensee/Administrator Penny Cook; House Manager Jessica BedoTIME COMPLETED:
03:30 PM
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An Annual Inspection Control visit was conducted on the date & times indicated above by Licensing Program Analyst (LPA) K. Mcclurg. LPA met with Licensee/Administrator (L/A) Penny Cook & House Manager (HM) Jessica Bedo. LPA reviewed the purpose of the visit with L/A & HM.

One central entry point has been designated for universal entry screening. Routine symptom screening including temperature taken & recorded daily for all staff, residents, & visitors.
Infection Control signs observed to be posted, including in bathrooms with hand washing techniques. Soap & paper towels available. Hand sanitizer available on entry & throughout the facility. Face coverings in use. Infection control policies & procedures & practices in place & currently applied.

No deficiencies issued.
Exit interview conducted with L/A & HM. Report Provided
SUPERVISORS NAME: Andy Xiong
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE: DATE: 06/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/25/2021
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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