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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206776
Report Date: 02/20/2024
Date Signed: 02/20/2024 03:27:20 PM


Document Has Been Signed on 02/20/2024 03:27 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:IDEAL CARE CENTERSFACILITY NUMBER:
107206776
ADMINISTRATOR:GONZALEZ, JOANNA RFACILITY TYPE:
740
ADDRESS:3618 W DAYTON AVETELEPHONE:
(559) 275-2488
CITY:FRESNOSTATE: CAZIP CODE:
93722
CAPACITY:6CENSUS: 6DATE:
02/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Joanna GonzalezTIME COMPLETED:
03:30 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
Licensing Program Analyst (LPA) Katie Brown arrived unannounced to conduct the Annual Inspection. LPA met with and explained the purpose of the visit with Administrator (AD) Joanna Gonzalez.

During this visit, LPA toured the facility inside & out. Resident bedrooms are found in good repair, contained required furnishings and lighting. The resident bathrooms were clean and in good repair. LPA observed required hygiene items and grab bars. Towels, extra bedding, and linens were stored and available for use. The kitchen was clean, in good repair with necessary items and appliances. LPA observed required food supply, PPE and paper product storage. Knives/sharps, cleaning/disinfecting supplies and chemicals are locked and stored separate from food. Medications are centrally stored in a locked cabinet. A First aid kit contained required items. There are visitation areas available inside and out. Doors and passageways are unobstructed throughout the facility. LPA observed a self-releasing gate and windows have screens in good repair. Smoke and Carbon Monoxide detectors were tested during the visit. The Fire extinguishers were serviced 9/21/23 by Jorgenson Co. LPA conducted resident and staff file reviews including medication audit.

Deficiencies are being cited in accordance with California Code of Regulations on the attached LIC 809-D in the areas of: Plan of Operation and Allowable Health Conditions and the Use of Home Health Agencies.



An exit interview was conducted and Plan of Correction (POC) developed. A copy of this report was signed by AD and Appeal Rights were provided.

LPA requested the following updated forms faxed to CCLD by 3/5/2024: Designation of Facility Responsibility (Lic308), Administrative Organization (Lic309), Emergency Disaster Plan (LIC610D), Affidavit Regarding Client/Resident Cash Resources (LIC 400), Surety Bond (Lic402) Personnel Report (LIC 500). Client Roster (LIC 9020), Proof of current Liability Coverage.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie BrownTELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:
DATE: 02/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/20/2024
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 6


Document Has Been Signed on 02/20/2024 03:27 PM - It Cannot Be Edited

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: IDEAL CARE CENTERS
FACILITY NUMBER: 107206776

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/20/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87208(a)(12)
Plan of Operation
(a) Each facility shall have and maintain a current, written definitive plan of operation. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following: (12) The Infection Control Plan pursuant to Section 87470.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview and record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. The Administrator is names as the Infection Control Lead. AD has not been trained as the Lead as required.
POC Due Date: 03/05/2024
Plan of Correction
1
2
3
4
AD has agreed to register for and complete all required training for the position of the Infection Control Lead. AD will submit a certificate of completion to CCLD by the POC date.
Type B
Section Cited
CCR
87609(b)(4)
Allowable Health Conditions and the Use of Home Health Agencies
(b) Incidental medical care may be provided to residents through a licensed home health agency provided the following conditions are met: (4) The licensee and home health agency agree in writing on the responsibilities of the home health agency, and those of the licensee in caring for the resident's medical condition(s).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review and interview, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. The facility does not have a written agreement with the Home Health Agency for R2.
POC Due Date: 03/05/2024
Plan of Correction
1
2
3
4
AD has agreed to create and submit a copy of a signed/complete Home Health agreement for R2 to CCLD by the POC date.
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: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie BrownTELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:
DATE: 02/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/20/2024
LIC809 (FAS) - (06/04)
Page: 2 of 6