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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206900
Report Date: 11/18/2021
Date Signed: 11/18/2021 04:11:46 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:RATANAKONE HOMEFACILITY NUMBER:
107206900
ADMINISTRATOR:RATANAKONE, KEVINFACILITY TYPE:
740
ADDRESS:2220 N. PROSPECTTELEPHONE:
(559) 287-6366
CITY:FRESNOSTATE: CAZIP CODE:
93722
CAPACITY:6CENSUS: 4DATE:
11/18/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Dean Murphy IVTIME COMPLETED:
05:00 PM
NARRATIVE
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LPA Katie Brown arrived at the facility unannounced to conduct a POC visit. LPA met with Administrator Dean Murphy. LPA explained the purpose of the visit.

The purpose of this visit is for LPA to confirm POC completion. Administrator and LPA toured the facility to confirm that POC was met. Letters of Deficiency Citations Cleared provided to Administrator.




See 809-D for Deficiencies cited during this visit.

A copy of this report along with Appeal Rights and an Exit Interview was conducted with the Administrator.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Katie BrownTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021
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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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: RATANAKONE HOME
FACILITY NUMBER: 107206900
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/18/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/18/2022
Section Cited

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87412 Personnel Records
(g) All personnel records shall be maintained at the facility and shall be available to the licensing agency for review.

This requirement was not met as evidenced by:
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Licencee does not have complete Personnel file for all current staff. The Personnel files are not maintained at the facility.

This poses a potential health and safety risk to persons in care.
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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) 650-7923
LICENSING EVALUATOR NAME: Katie BrownTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 11/18/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/18/2021
LIC809 (FAS) - (06/04)
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