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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107204087
Report Date: 11/22/2024
Date Signed: 11/22/2024 03:32:09 PM

Document Has Been Signed on 11/22/2024 03:32 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:BRYLAND ADULT RESIDENTIAL FACILITY, LLCFACILITY NUMBER:
107204087
ADMINISTRATOR/
DIRECTOR:
WILLIS BRYANT, MIESHUNFACILITY TYPE:
735
ADDRESS:510 E. TOWERTELEPHONE:
(559) 475-0011
CITY:FRESNOSTATE: CAZIP CODE:
93706
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
11/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:05 PM
MET WITH:Administrator, Mieshun Willis-BryantTIME VISIT/
INSPECTION COMPLETED:
03:46 PM
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On 11/22/2024, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an annual inspection. There were no staff present upon LPA's arrival. LPA contacted Administrator via telephone, introduced self and stated the purpose of the visit. Facility staff arrived at the facility and granted LPA entry. Administrator, Mieshun Willis-Bryant arrived shortly after. LPA met with Administrator.

LPA conducted a facility tour with staff. Common areas were furnished with adequate lighting available. Kitchen toured and observed to be clean and safe for food preparation. Fire extinguisher observed to be last serviced on 12/12/2023. LPA observed an adequate food supply. Medications were observed to be locked and inaccessible to clients in care. Bedrooms toured and observed to have required furnishings. LPA observed an adequate supply of linens and hygiene products. Bathrooms were toured and observed to be operational. Hot water measured at 114.2 degrees F. Smoke detector and carbon monoxide detector observed to be operational during today's inspection. Exterior tour conducted. All exits open and free from obstructions, no fire clearance issues observed.

LPA reviewed facility records. Clients records were reviewed for required documents including IPP and physician's reports. Staff records were reviewed for required documents including health screen, fingerprint clearance, and medication training. Emergency disaster plan reviewed. Last fire drill was conducted on 10/28/2024. Medications reviewed and observed to be administered as prescribed.

No deficiencies issued during today's inspection. Exit interview conducted. A copy of this report was discussed and provided to Administrator, Mieshun Willis-Bryant, whose signature on this form confirms receipt of this document.

LPA is requesting the following documents be submitted to the Fresno CCL office by 12/06/2024: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Emergency and Disaster Plan, Personnel Report (LIC500), Register of Facility Clients/Residents for LIC9020.
Melinda HoffmannTELEPHONE: (559) 341-3274
Alexandria WaltonTELEPHONE: (559) 246-0128
DATE: 11/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2024
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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