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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107204051
Report Date: 06/15/2021
Date Signed: 06/15/2021 03:22:09 PM

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:CARING HEARTS HOME OF CLOVISFACILITY NUMBER:
107204051
ADMINISTRATOR:MARIETTA B PARANGALANFACILITY TYPE:
740
ADDRESS:2766 KEATS AVENUETELEPHONE:
(559) 297-6771
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY:6CENSUS: 3DATE:
06/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:38 AM
MET WITH:Caregiver, Elias CristobalTIME COMPLETED:
12:45 PM
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On 06/15/2021, Licensing Program Analyst (LPA) A. Walton arrived unannounced to conduct an Annual Required Inspection. LPA introduced self, stated the purpose of the visit and requested to speak with the Administrator. Facility staff contacted Administrator, Marietta Parangalan, who was unable to attend this inspection. LPA received verbal permission from Administrator to conduct the inspection with Caregiver, Elias Cristobal.

LPA conducted a tour of the facility with Caregiver. Visitor check-in/screening was observed upon entering the facility. Facility has one entry and one exit point. Facility appeared cleaned with no obstruction or fire clearance issues. LPA observed signs promoting social distancing, hand-washing, and cough/sneeze etiquette. Bathrooms were stocked with liquid soap and paper towels. LPA observed at least 6 feet between resident beds.

LPAs checked residents’ locked medications. Food supply was checked and there appeared to be an adequate supply. Cleaning and PPE supplies were checked. Staff records were reviewed for good health and infection control training. Residents wear masks when away from the facility. Resident’s files have updated emergency contact information. Administrator certification is current.

No deficiencies issued.

An exit interview was conducted with Caregiver as well as with Administrator via telephone. As a COVID-19 precautionary measure, a copy of this report will be provided via email and an electronic read receipt confirms receiving this document. Administrator was informed to select yes when prompted to send a read receipt. Facility Representative signature on file.

SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021
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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