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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206809
Report Date: 06/24/2022
Date Signed: 06/24/2022 01:39:09 PM


Document Has Been Signed on 06/24/2022 01:39 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:EDWARDS TENDER LOVING CARE & MOREFACILITY NUMBER:
107206809
ADMINISTRATOR:EDWARDS, LAURAFACILITY TYPE:
740
ADDRESS:6775 W STUART AVETELEPHONE:
(559) 515-6458
CITY:FRESNOSTATE: CAZIP CODE:
93723
CAPACITY:6CENSUS: 3DATE:
06/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Laura EdwardsTIME COMPLETED:
01:50 PM
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On 6/24/2022, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required Inspection. LPA met with Licensee, Laura Edwards and stated the purpose of the visit. A tour of the facility was conducted. COVID-19 guidelines are in place. Visitor log-in/temperature check was observed upon entry. Facility has one entrance/exit point, all staff and visitors enter through front door. Laura Edwards also serves as facility Administrator, Certificate #6034405740, expires 11/22/2022.

Facility appeared clean with no obstruction or fire clearance issues. Hand sanitizer was readily available to resident and visitors. Hand washing basin available in laundry room for all staff and visitors after initial screening. Social distancing is maintained in the common and dining areas. Bathrooms toured, hand washing posters were observed by the bathroom sink. Resident bedrooms toured, there are 4 private resident rooms and 1 room with double occupancy. Shared bedroom observed to have adequate spacing between beds. Food supply observed to be adequate for the residents in care.

Fire extinguisher present and has a service date of 01/24/2022. Carbon monoxide detector and smoke detectors present and observed to be operational during today's inspection. Water temperature measured at 109 degrees F.

Administrator to send LIC 500, LIC 610 and LIC 9020 to Fresno CCL office no later than 7/05/2022.

No deficiencies observed during inspection. Exit interview conducted. A copy of this report was provided to licensee.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 06/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/24/2022
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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