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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208936
Report Date: 07/25/2022
Date Signed: 07/25/2022 09:33:16 AM


Document Has Been Signed on 07/25/2022 09:33 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:DEANNA'S PLACEFACILITY NUMBER:
107208936
ADMINISTRATOR:BENOV, DEANNA LFACILITY TYPE:
740
ADDRESS:951 E ALLUVIAL AVETELEPHONE:
(559) 570-8763
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:6CENSUS: 6DATE:
07/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:43 AM
MET WITH:Administrator, Deanna BenovTIME COMPLETED:
09:50 AM
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On 07/25/2022, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with Administrator, Deanna Benov.

LPA conducted a facility tour with Administrator. Facility pathways were clear from obstructions. Entrances and exits were clear. No fire clearance issues observed. Hand sanitizer dispenser observed at the front entrance. Social distancing maintained in common and dining areas. LPA observed signs promoting social distancing, cough/sneeze etiquette. Bathrooms observed to be stocked with paper towels and liquid soap. Hand-washing signs observed in resident bathrooms. Bedrooms are single occupant with 1 shared bedroom.

LPA checked residents' medication for a 30 day supply. Medications observed to be locked and secure. Food supply checked. LPA observed a 7 day supply of non-perishable food items and a 2-day supply of perishable food items. Facility has at least a 30 day supply of cleaning supplies and PPE. Staff records reviewed for good health. Resident records observed to have updated emergency contact information.

No deficiencies observed during this inspection.

LPA is requesting the following documents be submitted to the Fresno CCL office by 08/08/2022: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance, Emergency and Disaster Plan (LIC 610E), Personnel Report (LIC500), Register of Facility Clients/Residents (LIC9020A).

An exit interview was conducted with Administrator. A copy of this report was discussed and provided to Administrator, Deanna Benov whose signature on this form confirmed receipt of this document.

SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:
DATE: 07/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/25/2022
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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