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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202769
Report Date: 01/25/2024
Date Signed: 01/25/2024 02:19:55 PM


Document Has Been Signed on 01/25/2024 02:19 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: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:
01/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:48 AM
MET WITH:Alicia WebbTIME COMPLETED:
02:19 PM
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On 1/25/2024, Licensing Program Analyst (LPA) Melinda Medina conducted an unannounced Annual Required inspection. LPA toured the facility with Administrator, Alicia Webb.

Physical plants toured. Facility tour began in resident rooms. LPA toured resident bedrooms 2, 8, 9, 10, 12, 19, 28, 36, 39, and 42. Facility is maintained at a comfortable temperature. LPA found all resident living facility had all the required accommodations. Lighting in the bedrooms appeared to adequate. Water temperature measured ranged from 114 degrees F. to 120 degrees F. Grab bars and nonskid mats or surfaces were observed in all of the resident bathrooms toured. The common areas, sun room, activities room and dining room were all toured. LPA observed adequate seating and lighting for residents throughout facility. LPA observed residents participating in different activities throughout facility tour. The kitchen was toured. LPA observed supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days. Menus observed to be posted and available for residents. Resident files reviewed. Staff files reviewed. Medications observed to be locked in medication room and inaccessible to residents. Medications reviewed and observed to be given as prescribed,

All indoor and outdoor passageways are free of obstructions. Signal system was checked, it took staff approximately 13 seconds for staff to respond. Fire extinguisher all have current service dates of 5/11/2023.

LPA received update LIC 500 and copy of liability insurance during visit. Administrator to submit copy of Administrator's Certificate, LIC 308, LIC 9020 to Fresno Regional Office no later than 2/2/2024.

No deficiencies cited during inspection.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/25/2024
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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