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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206649
Report Date: 12/20/2021
Date Signed: 12/20/2021 12:30:10 PM

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:SUNRISE OF FRESNOFACILITY NUMBER:
107206649
ADMINISTRATOR:BREWER, NORSHELLFACILITY TYPE:
740
ADDRESS:7444 N. CEDARTELEPHONE:
(559) 325-8170
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:89CENSUS: 75DATE:
12/20/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:34 AM
MET WITH:Administrator, Norshell BrewerTIME COMPLETED:
12:09 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
On 12/20/2021, Licensing Program Analyst (LPA) Walton arrived unannounced at the above facility to conduct an Annual Inspection-Infection Control. LPA introduced self, stated the purpose of the visit and requested to speak with the Administrator. LPA met with Administrator (ADM), Norshell Brewer. Facility has one central entry and exit point. Upon entry, LPA observed visitor log-in/temperature check.

LPA conducted a facility tour with ADM. All pathways, entrances and exits were clear from obstructions. No fire clearance issues. LPA observed signs promoting hand-washing, social distancing, and cough/sneeze etiquette. Facility staff observed to be wearing facial coverings. LPA toured the facility kitchen. LPA observed a 7-day supply of perishable foods and a 2-day supply of perishable foods. LPA observed a 30 day supply of PPE and cleaning supplies. LPA checked residents' medications and observed a 30 day supply. Resident and staff temperature checks are documented daily.

Residents at the above facility have private apartments. LPA observed hand sanitizer dispensers in the facility hallways. Facility bathrooms were stocked with paper towels and liquid soap. Hand-washing signs observed in common bathrooms. Resident records have updated emergency contact information. Personnel records reviewed for good health.

LPA is requesting the following documents be submitted to the Fresno CCL office by 01/02/2022: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance Emergency and Disaster Plan (LIC 610E, Personnel Report (LIC500), Register of Facility Clients/Residents for LIC9020A


No deficiencies issued during this inspection. Exit interview conducted. As a COVID-19 precautionary measure, a copy of this report will be provided via email and an electronic read receipt confirms receiving this document. Report signed on-site.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021
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