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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209303
Report Date: 11/15/2024
Date Signed: 11/15/2024 09:51:12 AM

Document Has Been Signed on 11/15/2024 09:51 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:PSALMS 23 LOVING CARE RESIDENTIAL IIIFACILITY NUMBER:
107209303
ADMINISTRATOR/
DIRECTOR:		COOLEY, I'ISHAFACILITY TYPE:
735
ADDRESS:441 W ALLUVIAL AVETELEPHONE:
(559) 270-3822
CITY:PINEDALESTATE: CAZIP CODE:
93650
CAPACITY: 4CENSUS: 2DATE:
11/15/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:I'IshaTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
NARRATIVE
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An Office Meeting was conducted on this date to review and discuss the Audit Report completed for the facility. Present during the meeting were:

Brenda White, Regional Manager
See Moua, Licensing Program Manager
Alexandria Walton, Licensing Program Analyst
Mai Yang, Licensing Program Analyst
Martin Vega, Licensing Program Analyst
I’Isha Cooley, Licensee

An audit was completed for the facility and licensee because of concerns regarding residents’ P&I funds during annual visit 7/2/2024. Based on the records reviewed, the following allegations were substantiated and citations were issued during today’s meeting.

1. The facilities’ Personal & Incidental (P&I) records were not completed: 80026(h) Safeguards for Cash Resources, Personal Property, and Valuables of Residents - Each licensee shall maintain accurate records of accounts of cash resources, personal property, and valuables entrusted to his/her care…
Based on the documents that were reviewed, it disclosed that clients received their P&I money, but facilities did not credit clients’ P&I money on Record of Client’s Safeguarded Cash Resources, LIC 405 for several months. Therefore, the LIC 405 is not completed.


Continued on LIC 809C
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Martin Vega
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: PSALMS 23 LOVING CARE RESIDENTIAL III
FACILITY NUMBER: 107209303
VISIT DATE: 11/15/2024
NARRATIVE
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2. The surety bond is not enough to cover the money handled by facilities: 80025(c) Bonding- The amount of the bond shall be according to the following schedule… Every further increment of $1,000 or fraction thereof shall require an additional $1,000 on the bond.
Based on the records reviewed, the surety bond is not sufficient to cover the money handled by licensee for Psalms 23 Loving Care Residential and Psalms 23 Loving Care Residential IIII.
3. Licensee commingled business funds with clients’ funds: 80026(e) Safeguards for Cash Resources, Personal Property, and Valuables of Residents - Cash resources, personal property, and valuables of clients shall be separate and intact, and shall not be commingled with facility funds or petty cash.
Based on the bank statement reviewed, it revealed the licensee commingled business funds and clients’ funds together.
4. 80063(a) Accountability - The licensee, whether an individual or other entity, is accountable for the general supervision of the licensed facility, and for the establishment of policies concerning its operation.
Based on the records reviewed, the licensee failed to follow cash handling guidance and procedures.

Plan of corrections were discussed with the licensee on the attached 809-D. The licensee agrees to submit all POCs by the due date.

Technical Support Program (TSP) services offered to Licensee, referral will be made.


Exit interview was conducted and appeal rights were provided during the meeting.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Martin Vega
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 11/15/2024 09:51 AM - It Cannot Be Edited


Created By: Martin Vega On 11/15/2024 at 08:32 AM
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: PSALMS 23 LOVING CARE RESIDENTIAL III
FACILITY NUMBER: 107209303

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/18/2024
Section Cited
CCR
80026(h)

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80026(h) Safeguards for Cash Resources, Personal Property, and Valuables of Residents - Each licensee shall maintain accurate records of accounts of cash resources, personal property, and valuables entrusted to his/her care…
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Licensee agrees to submit a written statement detailing the steps the facility will take to ensure the requirements for this section are met to the Fresno CCL office by the POC due date.
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Based on the documents that were reviewed, it disclosed that clients received their P&I money, but facilities did not credit clients’ P&I money on Record of Client’s Safeguarded Cash Resources, LIC 405 for several months. Therefore, the LIC 405 is not completed.
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Type A
11/18/2024
Section Cited
CCR80025(c)

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80025(c) Bonding- The amount of the bond shall be according to the following schedule… Every further increment of $1,000 or fraction thereof shall require an additional $1,000 on the bond.
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Licensee agrees to submit a written statement detailing the steps the facility will take to ensure the requirements for this section are met to the Fresno CCL office by the POC due date.
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Based on the records reviewed, the surety bond is not sufficient to cover the money handled by licensee for Psalms 23 Loving Care Residential and Psalms 23 Loving Care Residential IIII.
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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:Brenda Chan
LICENSING EVALUATOR NAME:Martin Vega
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2024


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 11/15/2024 09:51 AM - It Cannot Be Edited


Created By: Martin Vega On 11/15/2024 at 08:38 AM
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: PSALMS 23 LOVING CARE RESIDENTIAL III
FACILITY NUMBER: 107209303

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/18/2024
Section Cited
CCR
80026(e)

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80026(e) Safeguards for Cash Resources, Personal Property, and Valuables of Residents - Cash resources, personal property, and valuables of clients shall be separate and intact, and shall not be commingled with facility funds or petty cash.
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Licensee agrees to submit a written statement detailing the steps the facility will take to ensure the requirements for this section are met to the Fresno CCL office by the POC due date. To include the facility's plan to cease removing funds from the clients bank account
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Based on the bank statement reviewed, it revealed the licensee commingled business funds and clients’ funds together.
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Type A
11/18/2024
Section Cited
CCR80063(a)

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80063(a) Accountability - The licensee, whether an individual or other entity, is accountable for the general supervision of the licensed facility, and for the establishment of policies concerning its operation.
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Licensee agrees to submit a written statement detailing the steps the facility will take to ensure the requirements for this section are met to the Fresno CCL office by the POC due date. To include the facility's plan to review Title 22 regulationsr regarding safeguarding client resources
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Based on the records reviewed, the licensee failed to follow cash handling guidance and procedures.
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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:Brenda Chan
LICENSING EVALUATOR NAME:Martin Vega
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2024


LIC809 (FAS) - (06/04)
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