107209024-1-4-2024-24-AS-MFLS-CZ6QKD-20240104111409

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 107209024
Report Date: 01/04/2024
Date Signed: 01/04/2024 11:14:24 AM

Document Has Been Signed on 01/04/2024 11:14 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME:	DIAL FOR CARE INC.		FACILITY NUMBER:	107209024
ADMINISTRATOR:	RAMIZ ALCHI		FACILITY TYPE:	740
ADDRESS:	1472 E. SAMPLE AVE		TELEPHONE:	(559) 878-3138
CITY:	FRESNO	STATE: CA	ZIP CODE:	93710
CAPACITY:	6	CENSUS: 2	DATE:	01/04/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Shameka Turner		TIME COMPLETED:	11:25 AM

NARRATIVE

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Licensing Program Analyst (LPA) M. Flores arrived at the facility unannounced to conduct a required annual visit. LPA was granted entry by caregiver staff and explain the purpose of the visit. Administrator Ramiz Alchi approved for House Manager, Shameka Turner to complete this annual visit.

The residence was set at 71 degrees F temperature and free of passageway obstructions inside and outside. LPA observed four bedrooms in the residence. Residents' rooms were toured and inspected. Rooms were found to be clean, and furnishing was in good condition. Two of the rooms are currently occupied. Hot water temperature was measured at 109.8 degrees F.

Kitchen toured, supply of food observed, and food stored properly for perishable and nonperishable. Medication and knives are locked in the hallway closet. Cleaning supplies are kept locked in a cabinet inside the garage. Smoke and carbon monoxide are dual detectors, they were checked and operating. Fire extinguishers was service on 12/14/2023. Last drill completed on 12/27/23. Outdoor area was clean and free of obstruction.

During the visit a file review was conducted for residents and staff files, refer to 809D for deficiencies.

An exit interview was conducted, and a copy of this report was provided to House Manager, Shameka Turner whose signature confirms receipt.

LPA requested the following updated forms faxed to CCLD by 1/18/24: Designation of Facility Responsibility (LIC308), Administrative Organization (LIC309), Personnel Report (LIC 500), Proof of current Liability Coverage, LIC 8292, LIC 503 for caregiver staff.

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) -24-0610
LICENSING EVALUATOR NAME: Miriam Flores	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024

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 01/04/2024 11:14 AM - 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: DIAL FOR CARE INC.	FACILITY NUMBER: 107209024
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87465(d)(3)

Incidental Medical and Dental Care Services

(d) If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to communicate his/her symptoms clearly, facility staff designated by the licensee, shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (3) The date and time the PRN medication was taken, the dosage taken, and the resident's response shall be documented and maintained in the resident's facility record. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in 2 out of 4 persons which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 01/08/2024
	Plan of Correction
1 2 3 4	House Manager will complete staff training on medication and submit a copy of the training log by POC due date.

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: 01/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024

LIC809 (FAS) - (06/04)

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