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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206809
Report Date: 10/17/2023
Date Signed: 10/18/2023 08:15:10 AM


Document Has Been Signed on 10/18/2023 08:15 AM - 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: 5DATE:
10/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:01 AM
MET WITH:Laura Edwards, Administrator TIME COMPLETED:
12:15 PM
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On 10/17/23, Licensing Program Analyst (LPA) L. Salazar arrived to the facility unannounced to conduct the required Annual Inspection Visit. LPA was greeted by Administrator, stated the purpose of the visit and was allowed entry into the facility. Administrator on record is Laura Edwards.

LPA toured the facility inside and out and observed the facility temperature read at 71 degrees F. Resident bedrooms were observed to have the required lighting/furnishings and are free from odor and passageway obstruction/fire hazards. Bathrooms were observed to have operational lights, running water, and non- slip floors. Hot water temperature tested at 110 degrees F.

Cleaning supplies were observed to be locked cabinet located in the garage. LPA toured the kitchen observed the required 7-day supply of non-perishable food and 2- day supply of fresh perishables to be properly stored. Menus for the facility were observed.

Carbon monoxide detectors were observed to be operational. A fire extinguisher was observed with a service date of 01/09/23. First aid kits were observed to contain all required items. Medications were observed to be locked cabinet located the laundry room. Quarterly Emergency Disaster Drill logs were observed for staff.



A sample of Resident and Staff files were reviewed and observed to have the required forms. LPA is requesting the following documents be submitted to the Fresno CCL office by 11/03/2023: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Personnel Report (LIC500), Register of Facility Clients/Residents (LIC9020A).

An exit interview was conducted with Administrator. A copy of this report was discussed and provided at the time of visit. No deficiencies cited on today's visit.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:
DATE: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/17/2023
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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