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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 150406808
Report Date: 08/30/2022
Date Signed: 08/31/2022 04:21:59 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 08/31/2022 04:21 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:DAI BREAKFACILITY NUMBER:
150406808
ADMINISTRATOR:CORNELL, BEVERLYFACILITY TYPE:
775
ADDRESS:14150 1/2 SUNSET BLVD.TELEPHONE:
(661) 854-4543
CITY:ARVINSTATE: CAZIP CODE:
93203
CAPACITY: 40CENSUS: 35DATE:
08/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Licensee, Beverly CornellTIME COMPLETED:
01:00 PM
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On 08/30/2022, Licensing Program Analyst (LPA) L. Salazar arrived unannounced to the facility to conduct an Annual Infection Control Inspection. LPA introduced self, stated the purpose of the visit, and was allowed entry into the facility. LPA met with Licensee, Beverly Cornell.

Log-in/temperature check are taken daily. Clients are exhibiting their personal rights due to behaviors, they are not wearing masks, however, social distances is practiced in all six rooms of the facility. Facility has one entrance/exit point. Hand sanitizer was readily available to clients and visitors. Hand washing and other various Covid-19 related signs were observed in the common areas.

All passageways and exits were clear and free from obstruction. Facility inside temperature read at 74 degrees. Rooms were well lit an free from odor. Clients are observed eating lunch in their classrooms. Activity areas were clean and odor free. Bathrooms were clean and fixtures were functioning properly.

Facility Mitigation plan has been received and added to facility file. Infection control procedures described in the plan which were observed or reviewed by LPA during the visit include: Daily symptoms screenings (for staff, persons in care and visitors),visitation policy, quarantine/isolation procedures, infection control and disinfecting procedures that include a designated person to disinfect every touch point, staffing plan, Personal Protection Equipment (PPE) storage and use, infection control training, communication procedures. Licensee/Administrator is identified as the Infection Control Lead for the program.

(Continued on 809-C)
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: DAI BREAK
FACILITY NUMBER: 150406808
VISIT DATE: 08/30/2022
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(continued from 809)

LPA toured the facility inside. Required postings such as hand washing, coughing etiquette and physical distancing were observed in the facility. Sinks observed to be stocked with liquid soap, paper towels and covered trash cans in restrooms. Through LPA’s observations and interview with licensee, the required infection control practices are found to be in compliance. No deficiencies cited on today’s inspection.

An exit interview was conducted. The following documents are requested and need to be submitted to Fresno CCL by 9/16/2022. Designation of Facility Responsibility LIC308, Administrator Organization LIC309, Personnel Report LIC500, Emergency and Disaster Plan LIC610D, and Register of Facility Clients LIC9020.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022
LIC809 (FAS) - (06/04)
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