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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107204168
Report Date: 09/20/2021
Date Signed: 09/20/2021 11:11:52 AM

Document Has Been Signed on 09/20/2021 11:11 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:MANNING HOMEFACILITY NUMBER:
107204168
ADMINISTRATOR:MARTINEZ, LUPEFACILITY TYPE:
735
ADDRESS:767 MANNING AVENUETELEPHONE:
(559) 638-9804
CITY:REEDLEYSTATE: CAZIP CODE:
93654
CAPACITY: 6CENSUS: 4DATE:
09/20/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:03 AM
MET WITH:Lupe Martinez
Dale Martinez		TIME COMPLETED:
11:15 AM
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LPA was met by Licensees, Lupe Martinez and Dale Martinez and stated the 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. Facility has one entrance/exit point, all staff and visitors enter through side entrance.

Facility appeared clean with no obstruction or fire clearance issues. Hand sanitizer was readily available to resident and visitors. Social distancing is maintained in the common and dining areas. Bathrooms have trash cans with lid. Hand washing posters were observed by the bathroom sink. Resident bedrooms toured, resident bedrooms have a minimum of 6 feet between beds.

Fire extinguisher present and has a service date of 06/10/2021. Carbon monoxide detector and smoke detectors present and observed to be operational during today's inspection.

LPA checked residents’ medications and observed a 30-day supply. Food supply was observed to be adequate for residents in care. Cleaning and PPE supplies were checked. Mitigation Plan submitted to Department and approved on 4/23/2021.

Licensee to submit the following documents to Fresno CCL office no later than 9/28/2021: Copy of Administrator Certificate, First Aid card, LIC 500, LIC 610, LIC 9020 and Updated facility sketch.

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: 09/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2021
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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