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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208850
Report Date: 07/02/2024
Date Signed: 07/03/2024 06:25:21 AM


Document Has Been Signed on 07/03/2024 06:25 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:LOVING HANDS CARE HOMEFACILITY NUMBER:
107208850
ADMINISTRATOR:PARANGALAN, MARIETTAFACILITY TYPE:
740
ADDRESS:6229 W. SAN CARLOS AVETELEPHONE:
(559) 492-2035
CITY:FRESNOSTATE: CAZIP CODE:
93723
CAPACITY:6CENSUS: 5DATE:
07/02/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Marietta Parangalan, AdministratorTIME COMPLETED:
04:30 PM
NARRATIVE
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On 07/02/24, Licensing Program Analysts (LPAs) L. Salazar and M. Medina arrived to the facility unannounced to conduct the required annual inspection visit. LPAs were greeted by Administrator, stated the purpose of the visit and were allowed entry into the facility. Administrator on record is Marietta Parangalan Certificate #6040535740, Exp. 07/29/2024.

LPAs toured the facility inside and out and observed 5 resident in the home at the time of visit. No residents are receiving Hospice services or Home Health care services. The facility temperature read at 76 degrees F. Resident bedrooms were observed to have the required lighting/furnishings and are free from odor and passageway obstruction/fire hazards. Carpets in bedrooms need to be cleaned. Bathrooms were observed to have operational lights, running water, and non- slip floors. Hot water temperature tested at 105 degrees F. Kitchen needs deep cleaning to include the stove, cabinets, refrigerator and microwave. Air filter vent in kitchen needs to be cleaned.

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.

Carbon monoxide detectors were observed to be operational. A fire extinguisher was observed with a service date of 06/12/24. First aid kits were observed to contain all required items. Medications were observed to be locked cabinet located in the hallway.


Required postings were observed. A sample of resident and staff files were reviewed and documented on a separate report by LPA Medina, and were observed to not have the proper documentation to support annual training for staff. Disaster Plan was observed to be complete.

Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 809-D. A plan of correction was developed by licensee and reviewed with LPA. An exit interview was conducted with Licensee. A copy of this report and appeal rights were discussed and provided at the time of visit.

LPA is requesting the following documents be submitted to the Fresno CCL office by 07/19/2024: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Personnel Report (LIC500), Register of Facility Clients/Residents (LIC9020A),
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:
DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/02/2024
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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Document Has Been Signed on 07/03/2024 06:25 AM - 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: LOVING HANDS CARE HOME
FACILITY NUMBER: 107208850

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/02/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87303(a)
Maintenance and Operation
The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs observation, the licensee did not comply with the section cited which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/12/2024
Plan of Correction
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Licensee will send LPA pictures showing proof of cleaning conducted by POC date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:
DATE: 07/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/02/2024
LIC809 (FAS) - (06/04)
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