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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209084
Report Date: 02/09/2023
Date Signed: 02/09/2023 11:37:36 AM

Document Has Been Signed on 02/09/2023 11:37 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:NEURORESTORATIVE FRESNO-CLOVISFACILITY NUMBER:
107209084
ADMINISTRATOR:MAMARIAN, RITAFACILITY TYPE:
735
ADDRESS:1245 S CLOVIS AVETELEPHONE:
(916) 263-6630
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY: 6CENSUS: 6DATE:
02/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:31 AM
MET WITH:Interim Administrator Adan RubalcavaTIME COMPLETED:
11:50 AM
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On 2/9/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection - Infection Control. LPA was greeted by staff Ashley Todd and granted entry. LPA introduced self, stated the purpose of the visit, and requested to meet with administrator. LPA met with Administrator Adan Rubalcava and conduct tour with LPA. All 6 clients were present during the inspection.

Upon entry facility staff was observed with facial mask. Visitor log-in/temperature check was observed. Bathroom designated for visitors and staff for hand washing station near entry. Hand sanitizer was available to clients and visitors. Facility has one entrance/exit point. Facility appeared cleaned with no obstruction. Social distancing is maintained in the common and dining areas. LPA observed COVID-19 related signs and cough etiquette postings in facility.

Food supply was checked and appeared to be an adequate supply. All clients’ room toured and observed to be adequately furnished and lit. LPA observed 6 bedrooms that are single occupant. All bathrooms observed trash bin with lid. LPA observed hand washing posting by all bathroom sink. LPA observed fire extinguisher served date: 08/15/22. LPA observed 30-day PPE supplies. Cleaning chemicals stored and locked in laundry room. The exterior tour was conducted. Outside free of debris and obstruction. All client records reviewed to have updated emergency contact information. Staff records were reviewed for good health and infection control training.

No deficiencies issued during this inspection.

Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 2/15/23. The following updated forms were requested: Lic 308, Lic 309, Lic 500, Lic 610D, Lic 808, Lic 9282, and current Administrator Certificate. A copy of this report was provided to the Administrator.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/09/2023
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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