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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107204054
Report Date: 05/14/2024
Date Signed: 05/14/2024 07:26:03 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 05/14/2024 07:26 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) 228-9342
CITY:FRESNOSTATE: CAZIP CODE:
93725
CAPACITY:6CENSUS: 2DATE:
05/14/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee/Administrator (L/A) Raquel CatacutanTIME COMPLETED:
06:00 PM
NARRATIVE
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An unannounced Annual Continuation visit was conducted by Licensing Program Analyst (LPA) K. Mcclurg. LPA met with Licensee/Administrator (L/A) Raquel Catacutan. The purpose of this visit is to re-address concerns observed during previous visit as well as continued facility inspection. L/A lives on premises with spouse.

Previous observations were reviewed & observed to be cleared &/or in process of being cleared. Interiors in need of wall/door surface general cleaning, &/or repair, replacement, painting, etc.

Outside areas toured. Front porch/patio used & designated as a smoking area. Front porch/patio area in need of general clean-up & de-cluttering. Area being used to store cleaning items & other hazardous chemicals in cabinet that is now locked. Items not in use &/or non-operational such as motorized wheelchair, & refrigerator are in need of removal.

Front driveway contains miscellaneous items that appear to be being stored there, including what looks to be metal fence panels.

Backyard has access to side yard with fenced area & drive-port with trailer, power tools, hand tools, yard equipment, gasoline, motor oil, etc. Large gate to this area observed to have lock that was unlocked. Area also has 1/2 panel of chain link/gate that is not secured & due to height, cannot maintain accessibility of hazardous items. Multiple use of extension cords & some cording appears to be hung in a manner that does not protect the integrity of cording exterior & insulation.

(Continued)
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) 580-4596
LICENSING EVALUATOR NAME: Kelly J. McClurgTELEPHONE: (559) 246-0435
LICENSING EVALUATOR SIGNATURE:
DATE: 05/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/14/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5


Document Has Been Signed on 05/14/2024 07:26 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: 05/14/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/14/2024
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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Licensee/Administrator removed obstruction to egress in resident bedroom & removed exterior string lights with interior extension cord(s). Correction made within same date oberved.
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1.) Bed/bed frame obstructing entry & egress point of resident bedroom; 2.) On front porch/patio a single nail was observed to be draped with multiple strands of string lights connected to electrical outlet through use of multiple extension cords including what appeared to be of the type rated for indoor use only.
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DEFICIENCY CLEARED.

Repeat Zero-Tolerance violation <10/19/2023>.
CIVIL PENALTY ISSUED
Immediate CP issued in the amount of $1,000.00.
Type A
05/14/2024
Section Cited
CCR87309(a)

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Storage Space. ...items which could pose a danger if readily available...shall be stored where inaccessible to clients. Observations: 1.)Front patio/porch: Unsecured string trimmer/edger & Unlocked cabinet
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L/A removed trimmer & locked cabinet @ front porch area & under kitchen sink.



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containing hazardous items including aerosol Brake Cleaner, aerosol Starting fluid, motor oil, heavy duty cleanser, misc. power tools, etc; 2.) Unlocked Laundry room & closet containing misc. detergent/cleansers, chemicals, etc.,3.) Unlocked cabinet under kitchen sink containing knives & misc. detergent/cleansers, chemicals,etc.; 4.) Back/side yard with trailer unlocked & 1/2 gate Leaving gasoline, propane, motor oil, misc power tools etc. accessible.
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Remaining issues & challenges to be discussed during Informal Office visit or NCC - to be determined (TBD)
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: 05/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/14/2024
LIC809 (FAS) - (06/04)
Page: 2 of 5


Document Has Been Signed on 05/14/2024 07:26 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: 05/14/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/17/2024
Section Cited
CCR
87465(h)(2)

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Incidental Medical and Dental Care. ...medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for... medication.
L/A's bedroom observed to be unlocked with multiple misc. medications accessible.
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Medications removed &/or stored in inaccessible area.

DEFICIENCY CLEARED.
Type A
05/14/2024
Section Cited
CCR
87307(d)(2)

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Personal Accommodations and Services. ...all facilities...shall be maintained in a state of good repair &...provide a safe and healthful environment.
Toilet in resident bathroom did not have a toilet seat. This poses an immediate risk of fall &/or injury, etc.
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A toilet seat was installed on toilet in resident bathroom

DEFICIENCY CLEARED.

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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: 05/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/14/2024
LIC809 (FAS) - (06/04)
Page: 3 of 5


Document Has Been Signed on 05/14/2024 07:26 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: 05/14/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/14/2024
Section Cited
CCR
87555(a)

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General Food Service Requirements. All food shall be selected, stored, prepared and served in a safe and healthful manner. 1.) Meat being defrosted on countertop; 2.) Food being stored in empty pickle jar;
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Defrosting meat & storage in used containers addressed by L/A.

DEFICIENCY CLEARED
Type B
05/14/2024
Section Cited
CCR
87555(b)(21)

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General Food Service Requirements. ...refrigerators...shall be kept clean & food stored to enable adequate air circulation to maintain...temperatures. Refrigerator very full posing potential rish of impeding air circulation necessary to maintain appropriate temperature.
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L/A moved items to another refrigerator during visit.

DEFICIENCY CLEARED
Type B
05/14/2024
Section Cited
CCR87303(a)

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Maintenance & Operations. The facility shall be clean, safe, sanitary & in good repair at all times. 1.) Resident bathroom requires cleaning @ base of toilet, toilet front sides bowl to floor, bulbs over sink dusted/cleaned; plunger stored on floor to back/side of toilet to be stored in a healthful manner; 2.) Hallway: ceiling vent dusty/dirty; doors & doorjams dirt/soild around doorknobs & surfaces at doorknob level; wals & doorframes have
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Immediate bathroom & ceiling vent issues addressed by L/A.

Remaining issues & challenges to be discussed during Informal or NCC to be determined (TBD)
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black markings/scraped paint most likely from wheelchaire use, & baseboards, etc., in need of repair &/or painting, etc.; 3.) Outside area in need of clean-up & removal of items including non-op appliances @ front, metal fencing @ side, materials behind shed, & other misc items.
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Remaining issues & challenges to be discussed during Informal Office visit or NCC - to be determined (TBD)
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: 05/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/14/2024
LIC809 (FAS) - (06/04)
Page: 4 of 5


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
VISIT DATE: 05/14/2024
NARRATIVE
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(Continued from previous page.)

Backyard towards back side area of property observed to be in need of general clean-up with storage of additional miscellaneous items in need of removal. Backyard behind shed in need of general clean-up & storage of items not in use to be removed from property. Area in backyard surrounded by short fencing in need of general clean-up & removal of items not in use, such as tall poles with concrete bases laying down.

Outside areas have a general appearance of disarray & in need of general clean-up, & removal of items not in use &/or broken. Storage to be maintained in a manner that is safe @ all times & in a manner to prevent items falling upon person, tripping, & possible fire hazards. Copious use of extension cords through-out facility, interior & exterior.

Deficiencies issued.
Immediate Civil Penalty for repeat Zero-Tolerance violation in the amount of $1,000.00 issued.

Exit interview conducted with L/A. Report provided.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) 580-4596
LICENSING EVALUATOR NAME: Kelly J. McClurgTELEPHONE: (559) 246-0435
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024
LIC809 (FAS) - (06/04)
Page: 5 of 5