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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208850
Report Date: 07/02/2024
Date Signed: 07/02/2024 03:55:24 PM


Document Has Been Signed on 07/02/2024 03:55 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: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:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
12:56 PM
MET WITH:Marietta ParangalanTIME COMPLETED:
04:15 PM
NARRATIVE
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On 7/02/2024, Licensing Program Analysts M. Medina and L. Salazar arrived to the facility unannounced to conduct the required Annual Inspection. LPAs stated the purpose of the visit and were allowed entry into the facility. LPAs met with Licensee/Administrator Marietta Parangalan, who conducted the tour of the facility with both LPAs.

LPA Medina reviewed a sample of staff and resident files. During review of staff files, LPA observed that the files did not contain the proper documentation to support annual training for staff. LPA reviewed Emergency Disaster plan and observed the binder to have the required updated information.

LPA Salazar will document the physical plant tour and inspection tool results on a separate report. No deficiencies cited.

Per California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are being cited on the attached 809-D. If not corrected, this poses a potential risk to the health safety and personal rights to residents in care.

An exit interview was conducted with Administrator. A copy of this report and appeal rights were provided during facility inspection.


SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
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 07/02/2024 03:55 PM - 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
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/09/2024
Section Cited
CCR
87411(c)

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All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69
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Administrator has agreed to accept referral and TSP services. LPA Salazar will make referral for TSP.
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This was not met as evidenced by 3 out of 3 staff files reviewed did not contain the proper documentation to support annual training for staff.
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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) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
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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