107208932-1-18-2024-24-AS-MFLS-CZLU37-20240118141303

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 107208932
Report Date: 01/18/2024
Date Signed: 01/18/2024 02:13:15 PM

Document Has Been Signed on 01/18/2024 02:13 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME:	MORGAN VALLEY RESIDENCE		FACILITY NUMBER:	107208932
ADMINISTRATOR:	CAUCHI, NANCY		FACILITY TYPE:	740
ADDRESS:	1676 E. ESCALON AVE		TELEPHONE:	(559) 365-8664
CITY:	FRESNO	STATE: CA	ZIP CODE:	93710
CAPACITY:	3	CENSUS: 2	DATE:	01/18/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	07:40 AM
MET WITH:	Nancy Cauchi		TIME COMPLETED:	02:20 PM

NARRATIVE

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Licensing Program Analyst (LPA) M. Flores arrived unannounced to conduct a required annual inspection. LPA announced the purpose of the visit and met with Licensee, Nancy Cauchi.

LPA toured the facility inside and out. LPA checked water temperature in resident’s bathroom which read at 114.9 degrees F. LPA observed fire extinguisher and was last service on 12/14/23. Kitchen toured, supply of food observed, and food stored properly for perishable and nonperishable. Knives are locked in the kitchen area. Medication is stored and locked next to the kitchen area. LPA observed three bedrooms which were properly furnished, had adequate lighting, and storage space. Cleaning supplies were locked in the laundry room.

Due to time constraints annual inspection was not completed at this time. No deficiencies and citations were issued at this time. LPA will return to the facility on another date to complete this annual inspection.

An exit interview was conducted and a copy of this report was provided to Licensee, Nancy Cauchi. No deficiencies were cited at this time.

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) -24-0610
LICENSING EVALUATOR NAME: Miriam Flores	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024

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 01/18/2024 02:13 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: MORGAN VALLEY RESIDENCE	FACILITY NUMBER: 107208932
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1569.618(c)(3)

Other Provisions

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date:
	Plan of Correction
1 2 3 4

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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 Pidgirny	TELEPHONE: (559) -24-0610
LICENSING EVALUATOR NAME: Miriam Flores	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024

LIC809 (FAS) - (06/04)

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