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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206609
Report Date: 04/18/2024
Date Signed: 04/18/2024 03:47:51 PM


Document Has Been Signed on 04/18/2024 03:47 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:DYER, ELIZABETHFACILITY TYPE:
740
ADDRESS:4844 E. GETTYSBURGTELEPHONE:
(559) 294-9080
CITY:FRESNOSTATE: CAZIP CODE:
93726
CAPACITY:18CENSUS: 11DATE:
04/18/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Interim Administrator (IAdmin) Misti HastingsTIME COMPLETED:
04:00 PM
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
A Case Management visit was conducted by Licensing Program Analyst (LPA) K. Mcclurg with Interim Administrator (IAdmin) during a Complaint visit. The purpose of the Case Management was to review requirements & process to request a Hospice Waiver.

Facility currently has Hospice Waiver for 3. Hospice waiver for 3 is currently full. An existing resident would like to return to facility, however is now needing hospice care services. There is not available waiver for resident, so would like to expand Waiver.

Reviewed Hospice Waiver process & how to request an increase, & if currently appropriate for the facility at this time.
Hospice Waiver Exception process reviewed, including additional documentation for resident to be included with request & submitted to the Department

Facility Hospice Waiver is specific to a facility vs. Hospice Waiver Exception is specific to a resident.

Explained that request is not guaranteed to be granted & that each type of request takes time for the Department to appropriately review for approval or denial.

IAdmin agrees to not take in any new or existing residents that need hospice care services during request process. Should facility accept resident admission or return prior to obtaining approved Waiver or Exception the facility will be out of compliance & will be cited accordingly.

Exit interview conducted with IAdmin. Report provided.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) 580-4596
LICENSING EVALUATOR NAME: Kelly J. McClurgTELEPHONE: (559) 246-0435
LICENSING EVALUATOR SIGNATURE:
DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2024
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 1