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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202769
Report Date: 01/19/2023
Date Signed: 01/19/2023 11:37:38 AM


Document Has Been Signed on 01/19/2023 11:37 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:CARRINGTON OF SHAFTERFACILITY NUMBER:
157202769
ADMINISTRATOR:ALICIA WEBBFACILITY TYPE:
740
ADDRESS:250 EAST TULARE AVENUETELEPHONE:
(661) 746-6521
CITY:SHAFTERSTATE: CAZIP CODE:
93263
CAPACITY:64CENSUS: 44DATE:
01/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:09 AM
MET WITH:Alicia WebbTIME COMPLETED:
11:50 AM
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On 1/29/23, Licensing Program Analysts (LPA) M. Medina arrived at the facility unannounced to conduct a annual infection control inspection. LPA met with Alicia Webb, Administrator and stated the purpose of the visit. COVID precautionary measures were taken at the time of entry. Front door is facility main entry point, LPA observed staff and visitors to all be wearing masks.

Facility Mitigation plan has been submitted to CCL. Infection control procedures continue to be followed. Administrator is identified as the Infection Control Lead for the facility.

LPA toured the facility inside and out. Furniture in common and dining areas are spaced to promote distancing. Staff were all observed wearing face coverings. Facility has multiple designated visitation areas available. LPA observed 30-day medication supply and PPE accessible to staff. Hand sanitizer readily available throughout the facility.

Through LPA’s observation, documentation review and interview with Administrator, the required infection control practices are found to be in compliance.

No deficiencies cited on todays visit.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/19/2023
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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