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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208930
Report Date: 06/02/2021
Date Signed: 06/10/2021 01:49:39 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:WINDHAM, THEFACILITY NUMBER:
107208930
ADMINISTRATOR:METZ, KELLYFACILITY TYPE:
740
ADDRESS:1100 E SPRUCE AVETELEPHONE:
(559) 449-8070
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:88CENSUS: 72DATE:
06/02/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Administrator, Kelly MetzTIME COMPLETED:
01:00 PM
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On 06/02/2021, Licensing Program Analyst (LPA) A. Walton arrived unannounced to conduct a Required - 1 Year Inspection. LPA introduced self, stated the purpose of the visit and requested to meet with Administrator. LPA met with Executive Director (ED), Kelly Metz and disclosed the purpose of the visit. Facility has one central entry and exit. Visitor log/temperature check observed at the front the entrance.

LPA conducted a facility tour with ED. Facility appeared to be clean and all exits were free from obstruction. Staff were observed to be wearing facial masks while in the facility. Residents observed to be wearing facial masks in common areas. Facility is sanitized at least once daily. Facility hallways were equipped with hand sanitizer dispensers. LPA observed residents and staff maintaining social distancing while in the common areas and dining room.

LPA toured a sample of resident bedrooms. Residents at the above facility occupy an apartment and do not share bedrooms. Hand-washing posters observed in resident bathrooms.

Resident medications are kept secure in the medication room. LPA observed a 30-day supply of medications. LPA observed the food supply, facility as an adequate supply of emergency food.

Staff records were reviewed for good health and infection control training. Residents files observed to have updated emergency contact information. Administrator submitted renewal for certification.

No deficiencies issued. Administrator was informed that as a COVID-19 precautionary measure, this report will be emailed with a read receipt request in lieu of a signature. LPAs explained that Administrator must select yes when prompted to send a read receipt.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2021
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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