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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209006
Report Date: 11/24/2021
Date Signed: 11/30/2021 12:18:36 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:RISING SUN CARE HOME INCFACILITY NUMBER:
107209006
ADMINISTRATOR:SINGH, PARDEEPFACILITY TYPE:
740
ADDRESS:154 N LIND AVETELEPHONE:
(559) 313-4515
CITY:CLOVISSTATE: CAZIP CODE:
93612
CAPACITY:6CENSUS: 6DATE:
11/24/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Care Giver, Marites PaggaoTIME COMPLETED:
03:51 PM
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On 11/24/2021, Licensing Program Analyst, M. Garza arrived at the facility unannounced to conduct the required Infection Control Inspection. LPA contacted Administrator, Pardeep Singh to complete COVID pre-screening. LPA was greeted by Caregivers John Paggao and Marites Paggao and were allowed entry into the facility. LPA observed a central entry point with a supply of hand sanitizer and a sign in policy that includes documented routine symptom screening for resident's, staff and visitors. Residents observed in the dining area and common area watching television.

Mitigation plan was received. COVID-19 procedures described in the plan include required postings, symptoms screenings (for staff, persons in care and visitors), testing, quarantine/isolation cohorts, infection control plan to include donning and doffing of Personal Protective Equipment. Staffing and sick leave plans are in place for emergency staffing and/or PPE shortages.

LPA toured the facility inside and out. Required postings of signs observed in restroom and hallway. Licensee to post additional signs throughout the facility. 1 of 2 staff observed wearing face coverings. Facility has designated visitation areas. Covered trash bins were observed. LPA did not observe a 30 day supply of PPE. Resident medications is 30 day supply. Sinks are well stocked and liquid soap for hand washing and paper towels for hand drying were observed. Technical Advisories provided for infection control deficiencies on todays inspection.

Due to COVID precautionary measures a copy of this report will be emailed to: risingsuncare@gmail.com. A delivered and read receipt serves as confirmation.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Mary GarzaTELEPHONE: (559) 365-9009
LICENSING EVALUATOR SIGNATURE:

DATE: 11/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2021
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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