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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206809
Report Date: 08/06/2024
Date Signed: 08/07/2024 11:17:37 PM

Document Has Been Signed on 08/07/2024 11:17 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/
DIRECTOR:		EDWARDS, LAURAFACILITY TYPE:
740
ADDRESS:6775 W STUART AVETELEPHONE:
(559) 515-6458
CITY:FRESNOSTATE: CAZIP CODE:
93723
CAPACITY: 6CENSUS: 5DATE:
08/06/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:32 PM
MET WITH:Laura Edwards, Licensee/Administrator TIME VISIT/
INSPECTION COMPLETED:
05:37 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 08/06/24, Licensing Program Analyst (LPA) L. Salazar arrived to the facility unannounced to conduct the required annual inspection. LPA was greeted by caregiver, Rosa Garcia, stated the purpose of the visit, and was allowed entry in the facility. Administrator (ADM) on record is Laura Edwards. LPA spoke to ADM via telephone and was allowed to begin the annual inspection with caregiver until Administrator's arrival. Administrator arrived to the facility shortly after the telephone call.

LPA toured the facility inside and out and observed the house to be a 5 bedroom, 3 bathroom house. LPA observed 4 residents in care at the time of visit. 3 out 5 residents were observed in the living room, sitting in individual recliners, watching game shows on TV. 2 out of 5 residents are receiving Hospice care services. 1 out of 5 residents are receiving Regional Center services.

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 or fire hazards. Mattresses and linen were observed in good condition. A supply of clean linens/towels were observed in a closet off the hall. Bathrooms were observed to have operational lights, running water, required grab bars and non- slip floors. Hot water temperature tested at 110 degrees F.

Cleaning supplies and knives were observed to be locked cabinet located in the laundry room. 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.

LPA observed fire extinguisher with a service date of 08/03/24. Smoke alarm detectors and carbon monoxide detectors were observed to be operational. Last Disaster Drill was a fire drill on 06/20/24. First aid kits were observed to contain all required items. Medications were observed to be in a locked cabinet located the laundry room. LPA reviewed a sample of residents' medications, MARS, and Centrally Stored Medication and Destruction Record (CSMDR) and observed medication to be logged according to physician's records.



(continued on 809-C)
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 08/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/06/2024
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 5
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: EDWARDS TENDER LOVING CARE & MORE
FACILITY NUMBER: 107206809
VISIT DATE: 08/06/2024
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
26
27
28
29
30
31
32
(Continued LIC809-C)

Required postings were observed for Personal Rights of Residents in RCFE, facility's visitation policy and LTCO and Complaint Poster. LPA reviewed staff and resident files and observed required forms and training records.

LPA toured outside and observed passageways to be clear and free from obstruction. A covered seating area under the patio was observed. Backyard gate is self-closing and self-latching.

LPA is requesting the following updated forms to be sent to the Regional Office by 08/19/24. LIC 9020; LIC 500; LIC 308; LIC 400 ; LIC 402; Proof of Liability Insurance.

An exit interview was conducted with Administrator. A copy of this report will be provided to Administrator via email. No deficiencies cited on today's visit.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024
LIC809 (FAS) - (06/04)
Page: 2 of 5