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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107204041
Report Date: 03/08/2022
Date Signed: 03/09/2022 10:26:24 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 03/09/2022 10:26 AM - 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-HUGHESFACILITY NUMBER:
107204041
ADMINISTRATOR:GIUDICI, YOLANDAFACILITY TYPE:
735
ADDRESS:4376 NORTH HUGHES AVENUETELEPHONE:
(559) 222-4221
CITY:FRESNOSTATE: CAZIP CODE:
93705
CAPACITY: 6CENSUS: 4DATE:
03/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator Yolanda Giudici TIME COMPLETED:
10:45 AM
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On 3/9/22, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection - Infection Control. LPA introduced self, stated the purpose of the visit, and request to meet with the Administrator. LPA met with caregiver Jesus Bangoy. LPA conducted a facility tour with caregiver. Administrator Yolanda Giudici arrived shortly. No client were present during tour.

Upon entry facility staff was observed with facial covering. Visitor log-in/temperature check was observed upon entry. Hand sanitizer was readily available to clients and visitors. Facility has one entrance/exit point. Facility appeared cleaned with no obstruction or fire clearance issues. Social distancing is maintained in the common and dining areas.

Social distancing and cough etiquette postings not observed. All bathrooms observed trash bin with lid. LPA observed hand washing posting by all sinks. Food supply was checked and appeared to be an adequate supply.

All clients’ room toured and observed to be adequately furnished and lit. LPA observed 1 shared client’s bed to be at least 6 feet apart and 2 single occupant room. LPA checked clients’ locked medications. LPA observed 30-day PPE supplies. Cleaning supplies were stored and locked in cabinet in covered patio.

The exterior tour was conducted. Outside free of obstruction. Staff records were reviewed for good health and infection control training. All clients record were reviewed to have updated emergency contact.

No deficiencies issued during this inspection.

Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 3/14/22. The following updated forms were requested: control of property. LPA received copy of Lic 308, Lic 309, Lic 500, Lic 9020, Lic 610D, and Administrator certificate.

Administrator was informed that as COVID-19 precautionary measure, this report will be provided via email. Report signed on-site.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2022
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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