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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206609
Report Date: 04/10/2024
Date Signed: 04/11/2024 02:20:36 PM

Document Has Been Signed on 04/11/2024 02:20 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:GETTYSBURG CHRISTIAN HOMEFACILITY NUMBER:
107206609
ADMINISTRATOR/
DIRECTOR:		DYER, ELIZABETHFACILITY TYPE:
740
ADDRESS:4844 E. GETTYSBURGTELEPHONE:
(559) 294-9080
CITY:FRESNOSTATE: CAZIP CODE:
93726
CAPACITY: 18CENSUS: 10DATE:
04/10/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:00 PM
MET WITH:Assistant Administrator (AA) Misti Hastings - by telephone & Caregiver 1 (CG1) Victoria MarkhamTIME VISIT/
INSPECTION COMPLETED:
07:15 PM
NARRATIVE
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An unannounced Case Management Health & Safety visit was conducted on the date & times indicated above by Licensing Program Analyst (LPA) K. Mcclurg. LPA entered facility, met with Caregiver 1 (CG1) Victoria Markham, introduced self, presented business care, & inquired in Administrator or Assistant Administrator (AA) Misti Hastings was on the premises. Neither were on the premises. CG1 called AA. LPA spoke with AA, introducing self & stating purpose of visit. LPA inquired about the 2 staff on the premises.
LPA notified AA that CG1 was not associated to the facility. CG1 was verified as Fingerprint Cleared. Other staff working (CG2) was cleared & associated. Shared that a violation to these specific regulations carry an immediate Civil Penalty.
AA authorized CG1 to sign for today's Facility Inspection Report. LPA handed phone back to CG1 to let staff know they had authorized them to sign report.

Physical plant toured. Laundry room observed to be unlocked. Items accessible in laundry room included cleansers, chemicals, & nail polish remover. CG1 locked Laundry room @ time of visit making items inaccessible to residents.
Fire extinguisher service date observed as: 12/1/2023.

Citations issued. Immediate Civil Penalties assessed.

Exit interview conducted with AA by telephone. Report provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE: DATE: 04/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/10/2024
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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Document Has Been Signed on 04/11/2024 02:22 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 04/11/2024 01:46 PM


Created By: Kelly J. McClurg On 04/10/2024 at 05:14 PM
Link to Parent Document Below:
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: GETTYSBURG CHRISTIAN HOME
FACILITY NUMBER: 107206609

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/10/2024
Section Cited

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Storage Space: Disinfectants, cleaning solutions, poisons,...and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.
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 Laundry room observed to be unlocked. Items accessibly in laundry room included cleansers, chemicals, & nail polish remover.
This poses an immediate risk to residents.
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Type A
04/10/2024
Section Cited

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CRIMINAL RECORD CLEARANCE: Prior to working, residing or volunteering in a licensed facility, all individuals subject to a criminal record review shall request a transfer of a criminal record clearance from another facility...
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One of 2 staff on the premises @ time of visit (CG1) was not associated to this facility.
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IMMEDIATE CIVIL PENALTY ISSUED FOR $500.00.

AA to submit transfer documentation prior to CG1 working.

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 Moua
LICENSING EVALUATOR NAME:Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE:
DATE: 04/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/10/2024


LIC809 (FAS) - (06/04)
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