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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209137
Report Date: 08/29/2022
Date Signed: 08/29/2022 03:14:23 PM

Document Has Been Signed on 08/29/2022 03:14 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:MCWEALTH CARE INC. #6 DELBERT HOMEFACILITY NUMBER:
107209137
ADMINISTRATOR:GAYLORD, APRILFACILITY TYPE:
735
ADDRESS:6695 N DELBERT AVENUETELEPHONE:
(559) 293-3174
CITY:FRESNOSTATE: CAZIP CODE:
93722
CAPACITY: 4CENSUS: 4DATE:
08/29/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Brittany CastanadaTIME COMPLETED:
03:35 PM
NARRATIVE
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Licensing Program Analyst (LPA) Katie Brown arrived unannounced at the facility and conducted a Case Management visit with Brittany Castaneda.

During the facility visit, LPA discovered that two (2) staff who were present at the time of the visit were not associated to the facility.


See attached 9099D for citation issued in accordance with California Code of Regulations Title 22. An immediate civil penalty of $500 is assessed for each individual that has not been associated to the facility. The issuance of additional civil penalties is pending and currently under review. The details of additional civil penalties will be outlined in a future report to the facility, if any.

The following deficiencies were observed and noted on the attached LIC 809D. All violations that, if not corrected, will have direct and immediate risk to the health, safety or personal rights of clients in care.






An exit interview was conducted, and a Plan of Correction was developed and reviewed. A copy of this report and appeal rights were discussed and left with Brittany Castaneda, whose signature on this form confirm receipt of these documents.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Katie Brown
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2022
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 08/29/2022 03:14 PM - It Cannot Be Edited


Created By: Katie Brown On 08/29/2022 at 01:47 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: MCWEALTH CARE INC. #6 DELBERT HOME
FACILITY NUMBER: 107209137

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/29/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/30/2022
Section Cited
CCR
80019(e)(2)

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80019 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 80019(f)

This requirement was not met as evidenced by:
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CITATION CLEARED DURING VISIT
S2 was asked to leave the premisis and is aware not to return until the transfer process has been completed. Administrator was able to Associate S1 through Guardian during the visit.
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During a facility inspection, LPA discovered and verified that Staff (S1) and Staff (S2) were not associated to the facility - A Transfer had not been requested.

This poses an immediate health, safety and personal rights risk to persons in care.
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Administrator agrees to conduct an audit of staff Criminal Record Clearance and Assocuiation status to the facility and provide CCLD a copy of a revised roster with proof of clearance and association by 9/7/22.

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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:Sergiy Pidgirny
LICENSING EVALUATOR NAME:Katie Brown
LICENSING EVALUATOR SIGNATURE:
DATE: 08/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/29/2022


LIC809 (FAS) - (06/04)
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