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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206609
Report Date: 12/10/2021
Date Signed: 12/10/2021 10:47:39 AM

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:
12/10/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:41 AM
MET WITH:Staff, Vanita KempTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Darius Wiliams conducted an unannounced Annual Insepction visit. LPA Williams met with Staff, Vanita Kemp, and discussed the purpose of the visit. LPA D. Williams contacted Licensee, Elizabeth Dyer, via phone and discussed the purpose of the visit.

LPA Williams toured the facility with staff.

LPA Williams observed a visitor/temperature check log, and disinfection station at the front entrance. Facility has one entry and exit point. Social distancing is maintained in the common areas. Hand washing and other various Covid-19 related signs were observed in the common areas.

LPA Williams observed a two day supply of perishable food and seven day supply of non-perishable food. Cleaning supplies and medication were observed behind a locked door. Facility has the following Personal Protective Equipment available in storage; masks, gloves, gowns, and face shields.

Staff have received training in Covid-19 mitigation and infection control. 3 of 3 residents files had up to date emergency contact information.

Licensee agreed to submit the following documents to Community Care Licensing by 12/17/2021: Personnel Report (LIC 500), Designation of Facility Responsibility (LIC 308), and Administrator Certificate.

No deficiencies were cited at this time, an exit interview was conducted, and a copy of this report was provided.
SUPERVISOR'S NAME: Serigy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius WilliamsTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2021
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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