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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107204054
Report Date: 10/19/2023
Date Signed: 10/19/2023 07:45:03 PM


Document Has Been Signed on 10/19/2023 07:45 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:HAPPY LIVING FACILITYFACILITY NUMBER:
107204054
ADMINISTRATOR:CATACUTAN, RAQUELFACILITY TYPE:
740
ADDRESS:5275 E. KAVILANDTELEPHONE:
(559) 441-0351
CITY:FRESNOSTATE: CAZIP CODE:
93725
CAPACITY:6CENSUS: 3DATE:
10/19/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
06:00 PM
MET WITH:Care Giver (CG) Rey CatacutanTIME COMPLETED:
08:00 PM
NARRATIVE
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An unannounced Health & Safety check was conducted on the date & times above by Licensing Program Analyst (LPA) K. Mcclurg. Purpose of visit was to follow-up on reports of no supervision of residents in care & lock on front door inaccessible to residents preventing any egress in case of fire &/or an other emergencies. LPA met with Care Giver (CG) Rey Catacutan. LPA introduced self, stated purpose of visit & was allowed entry.

Standard chain lock observed at highest point of front door. Door over 6 feet high, & appeared to be approximately 8 feet high. Lock would not be accessible without ladder/step stool to latch or unlatch. LPA asked CG to remove lock immediately during visit. CG removed lock at time of visit.

LPA discussed absence of resident supervision when CG went to grocery store earlier in day (10/19/23). CG stated a staff person (1 person) was on premises when they (CG) went to grocery store, but that staff had fallen asleep during CG absence.

Deficiencies Issued.
Civil Penalties Issued

Exit interview conducted with CG. Reports provided including Appeal Rights
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) 580-4596
LICENSING EVALUATOR NAME: Kelly J. McClurgTELEPHONE: (559) 246-0435
LICENSING EVALUATOR SIGNATURE:
DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/19/2023
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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Document Has Been Signed on 10/19/2023 07:45 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710


FACILITY NAME: HAPPY LIVING FACILITY
FACILITY NUMBER: 107204054

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/19/2023
Section Cited
CCR
87203

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Fire Safety. All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic.
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Facility agreed to remove lock @ time of visit. Lock observed to be removed during visit.

Deficiency Cleared @ time of visit.
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Chain lock observed at top of front door. Top of door exceeded 6" & cannot be unlatched without use of ladder &/or step stool.
Immediate Risk
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Immediate Civil Penalty Issued. ($500.00)

NCC to follow.
Type A
10/19/2023
Section Cited
CCR87411(a)

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Personnel Requirements - General. Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs.
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Facility agrees to submit to the Department a Personnel Report (LIC500) showing staff schedule sufficient to meet needs of all residents @ all times.
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Absence of care & supervision for a duration of time. Staff not present or not available to meet resident needs.
Immediate Risk.
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Immediate Civil Penalty Issued ($500.00)
On-Going Civil Penatlies to be determined.

NCC to follow
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) 580-4596
LICENSING EVALUATOR NAME: Kelly J. McClurgTELEPHONE: (559) 246-0435
LICENSING EVALUATOR SIGNATURE:
DATE: 10/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/19/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2