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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209035
Report Date: 07/16/2021
Date Signed: 07/16/2021 02:22:50 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:TRUEWOOD BY MERRILL, CLOVISFACILITY NUMBER:
107209035
ADMINISTRATOR:FLAHERTY, TRACYFACILITY TYPE:
740
ADDRESS:675 W ALLUVIAL AVENUETELEPHONE:
(559) 325-8400
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY:148CENSUS: 117DATE:
07/16/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:11 AM
MET WITH:Tracy Flaherty, AdministratorTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Lady Cabrera conducted an Annual Inspection on this date. LPA was met by Administrator Tracy Flaherty and stated the purpose of the visit. Administrator reported the facility renovations were completed and at this time the facility is vacant. A tour of the facility was conducted. COVID-19 guidelines are in place. Visitor log-in/temperature check was observed upon entry. Facility has one entrance/exit point.

Facility appeared cleaned with no obstruction or fire clearance issues. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common and dining areas. Bathrooms have trashcans with lid. Hand washing posters were observed by the bathroom sink. Ten percent of Bedrooms were checked.

LPA checked residents’ medications and observed a 30-day supply. Food supply was checked and there appeared to be an adequate supply. Cleaning and PPE supplies were checked. Ten percent of Staff records were reviewed for good health and infection control training. Facility staff was observed with mask on. Residents are encouraged to wear masks when away from the community. Resident’s files have updated emergency contact information. Administrator certification is current.

No deficiencies were observed. Technical advisory notes were provided for all staff who are working with COVID-19 positive residents with fit testing for N95 respirators. Exit interview was conducted. Administrator was informed that as a COVID-19 precautionary measure, this report will be emailed to the Administrator.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Lady CabreraTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2021
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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