<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107204117
Report Date: 10/08/2021
Date Signed: 10/08/2021 10:31:44 AM

Document Has Been Signed on 10/08/2021 10:31 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:REYES RANCH LLCFACILITY NUMBER:
107204117
ADMINISTRATOR:JOSE DE LA CUEVAFACILITY TYPE:
735
ADDRESS:20022 EAST AMERICAN AVETELEPHONE:
(559) 637-0364
CITY:REEDLEYSTATE: CAZIP CODE:
93654
CAPACITY: 4CENSUS: 4DATE:
10/08/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:36 AM
MET WITH:Jose De La CuevaTIME COMPLETED:
10:44 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) was met by Jose De La Cueva, Administrator and stated purpose of the visit. A tour of the facility was conducted, COVID-19 guidelines are in place. Visitor log-in/temperature check was observed upon entry at facility entrance/exit point, all staff and visitors enter through front door.

Facility appeared clean with no obstruction or fire clearance issues. Social distancing is maintained in the common area and dining areas. Bathrooms have trash cans with lid. Hand washing posters were observed by the bathroom sink. Resident bedrooms toured, all residents have private rooms.

Fire extinguisher present and has a service date of 12/04/2021. Smoke detectors present and observed to be operational during today's inspection.

LPA checked residents’ medications and observed a 30-day supply. LPA observed a 2-day of perishable and a 7-day of non-perishable food available. Cleaning and PPE supplies were checked. Staff records were reviewed for good health and infection control training. Mitigation plan submitted to Department on 03/02/2021.

LPA provided copies of the following documents during inspection visit:: Copy of Administrator Certificate, First Aid card, LIC 500, LIC 610, and LIC 9020, LIC 308, LIC 402, LIC 309, LIC 9148 and Neighborhood Complaint Policy.

No deficiencies were observed. Exit interview was conducted. Administrator was informed that as a COVID-19 precautionary measure, this report will be emailed.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 10/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/08/2021
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 1