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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208987
Report Date: 12/14/2023
Date Signed: 12/14/2023 04:23:15 PM


Document Has Been Signed on 12/14/2023 04:23 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:CHERRY AND MICHAEL'S HOMEFACILITY NUMBER:
107208987
ADMINISTRATOR:ALACAR. CAROLINEFACILITY TYPE:
740
ADDRESS:4640 E. KAVILANDTELEPHONE:
(559) 515-6120
CITY:FRESNOSTATE: CAZIP CODE:
93725
CAPACITY:4CENSUS: 4DATE:
12/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Administrator (Admin) Caroline Alacar (telephone) & Program Manager (PM) Jason GavilanTIME COMPLETED:
04:30 PM
NARRATIVE
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An unannounced Annual/year visit was conducted on the date & times indicated above by Licensing Program Analyst (LPA) K. Mcclurg. LPA met with Program Manager (PM) Jason Gavilan, introduced self & asked if Administrator (Admin) Caroline Alacar was on the premises. Admin was not on the premises, however LPA was able to speak with Admin over phone. Admin authorized PM to sign for receipt of report.

Facility toured. Kitchen appeared to be clean & organized. Knives locked in drawer. 7 days Non-Perishable & 2 days Perishable food on the premises. Dining/living room sufficiently furnished & furnishings appeared to be in good repair. Resident rooms toured. Rooms sufficiently furnished & furnishings appeared to be in good repair. Resident bathrooms appeared & smelled to be clean with no unpleasant odors. Fixtures operational. Sinks in resident bathrooms on sensors so hot water was tested at kitchen faucet. Hot water measured at 124 degrees F. Hot water tank controls adjusted. All interior passageways & exits observed to be clear with no obstructions, including exit doors of each resident bedroom. Smoke & carbon dioxide detectors tested & operational. Fire extinguisher service date: 7/26/23

Outside area toured. Sufficient seating in good repair observed. Backyard area tidy. Passageway to exit gate clear & unobstructed. Garage access off of back yard observed to be locked making contents inaccessible to residents.

Deficiency issued.
Exit interview conducted with PM. Report provided @ time of visit.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) 580-4596
LICENSING EVALUATOR NAME: Kelly J. McClurgTELEPHONE: (559) 246-0435
LICENSING EVALUATOR SIGNATURE:
DATE: 12/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/14/2023
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 12/14/2023 04:23 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: CHERRY AND MICHAEL'S HOME
FACILITY NUMBER: 107208987

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/14/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87303(e)(2)
Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C).
Hot water in facility measured @ 124 degrees F.
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited abovewhich poses an immediate health & safety risk to persons in care.
POC Due Date: 12/15/2023
Plan of Correction
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Progam Manager agreed to submit a plan of how Hot Water will be adjusted to be within tolerances, including maintaining water log showing adjustment temperatures & final holding temperature for 2 days past water adjustment to temperature.
Copy of Plan to be submitted to the Department by end of day 12/14/23.
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: See MouaTELEPHONE: (559) 580-4596
LICENSING EVALUATOR NAME: Kelly J. McClurgTELEPHONE: (559) 246-0435
LICENSING EVALUATOR SIGNATURE:
DATE: 12/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/14/2023
LIC809 (FAS) - (06/04)
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