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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107204040
Report Date: 02/16/2022
Date Signed: 02/16/2022 02:18:13 PM


Document Has Been Signed on 02/16/2022 02:18 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:YELLOW ROSE RESIDENTIAL CARE HOME-NORWICHFACILITY NUMBER:
107204040
ADMINISTRATOR:GIUDICI, YOLANDAFACILITY TYPE:
735
ADDRESS:3333 W. NORWICH AVENUETELEPHONE:
(559) 222-4221
CITY:FRESNOSTATE: CAZIP CODE:
93722
CAPACITY:6CENSUS: 4DATE:
02/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:17 PM
MET WITH:Yolanda GiudiciTIME COMPLETED:
02:30 PM
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Licensing Program Analysts (LPA) Katie Brown arrived at the facility unannounced to conduct the Infection Control Inspection. LPA met with Administrator (AD) Yolanda Giudici. LPA entered through the central entry point where health screening was conducted. PPE and sanitizer was observed.

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 and all staff members are fully vaccinated and boosted.

LPA 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. LPA observed 30-day resident medication and PPE supply. Bathroom sinks are stocked with liquid soap and paper towels washing.
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No deficiencies cited for Infection Control Annual Inspection.

The following forms requested to be updated and submitted to LPA by 2/23/2022: A copy of current Liability Insurance. Administrator Certificate Expiration date 8/28/22.

A copy of this report and an exit interview was conducted with AD.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Katie BrownTELEPHONE: (559) 243-8080
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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