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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209169
Report Date: 09/19/2022
Date Signed: 09/19/2022 03:20:01 PM

Document Has Been Signed on 09/19/2022 03:20 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:CARING ANGELSFACILITY NUMBER:
107209169
ADMINISTRATOR:ALCAREZ, RACHELFACILITY TYPE:
735
ADDRESS:1689 SUSSEX AVENUETELEPHONE:
(559) 287-3472
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY: 6CENSUS: 0DATE:
09/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Licensee Swellen Medroso and Rachel Alcarez Administrator TIME COMPLETED:
03:30 PM
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On 09/19/22 at 02:00PM, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection - Infection Control. LPA knocked on the door and contacted the Licensee Swellen Medroso via telephone. At approximately 02:03PM Licensee stated no client and no staff present at facility. Rachel Alcarez Administrator arrived shortly. LPA introduced self, stated the purpose of the visit, and met with Administrator. Licensee Swellen Medroso LPA conducted tour with Administrator and Licensee. There are currently no client present during tour.

Upon entry facility staffs was observed with facial mask. Visitor log-in/temperature check was observed upon entry. Hand sanitizer was readily available to clients and visitors. Facility has one entrance/exit point. Facility appeared cleaned with no obstruction or fire clearance issues. Social distancing is maintained in the common and dining areas. Social distancing and cough etiquette postings not observed in facility. Hand washing signs not observed. LPA observed a two-day supply of perishable food and seven-day supply of non-perishable food. LPA observed 30-day PPE supplies.

No deficiencies issued during this inspection.

Exit Interview conducted. The following updated forms were requested to CCL by 09/26/22: Lic 308, Lic 400, Lic 402, Lic 500, Lic 610D and Lic 9282. A copy of this report was provided to Administrator via email.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2022
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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