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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209222
Report Date: 03/28/2024
Date Signed: 03/28/2024 02:05:20 PM


Document Has Been Signed on 03/28/2024 02:05 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:HAND IN HAND CARE HOMEFACILITY NUMBER:
107209222
ADMINISTRATOR:ZAPATA, MARTHAFACILITY TYPE:
740
ADDRESS:4361 W. FREMONT AVETELEPHONE:
(559) 389-0315
CITY:FRESNOSTATE: CAZIP CODE:
93722
CAPACITY:6CENSUS: 6DATE:
03/28/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Martha ZapataTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Katie Brown arrived unannounced to conduct the Annual Inspection. LPA met with and explained the purpose of the visit with Licensees Ronald Sandone, Yolonda Castigador and Administrator (AD) Martha Zapata.

During this visit, LPA toured the facility inside & out. Resident bedrooms are found to be in good repair, contained required furnishings and lighting. The resident bathrooms were clean and in good repair with faucets delivering hot water at 107 degrees. LPA observed required hygiene items and grab bars. Towels, extra bedding, and linens were stored and available for use. The kitchen was clean, with necessary items and appliances. LPA observed required food supply and paper product storage. Knives/sharps, cleaning/disinfecting supplies and chemicals are locked and stored separate from food. Medications are centrally stored in a locked closet. A First aid kit contained required items. There are visitation areas available inside and out. Doors and passageways are unobstructed throughout the facility. LPA observed a self-releasing gate and windows with screens in good repair. Smoke and Carbon Monoxide detectors were tested during the visit. The Fire extinguishers were purchased 5/11/23. LPA conducted resident and staff file reviews including medication audit. Emergency Disaster Plan and Infection Control Plans were reviewed during this visit.

There were no citations during this inspection. An exit interview was conducted and a copy of this report was provided..



LPA requested the following updated forms faxed to CCLD by 4/4/2024: Designation of Facility Responsibility (Lic308), Administrative Organization (Lic309), Affidavit Regarding Client/Resident Cash Resources (LIC 400), Emergency Disaster Plan (LIC610E), Personnel Report (LIC 500), Client Roster (LIC 9020), Proof of current Liability Coverage and Infection Control Plan.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie BrownTELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:
DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/28/2024
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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