157203358-7-1-2024-24-AS-LSAR-D6RJ3R-20240701064200

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 157203358
Report Date: 06/18/2024
Date Signed: 07/01/2024 06:42:18 AM

Document Has Been Signed on 07/01/2024 06:42 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:	POSITIVE DIRECTIONS #9		FACILITY NUMBER:	157203358
ADMINISTRATOR:	MARIA ORTIZ		FACILITY TYPE:	740
ADDRESS:	329 EL CAMINO DRIVE		TELEPHONE:	(661) 721-3525
CITY:	DELANO	STATE: CA	ZIP CODE:	93215
CAPACITY:	4	CENSUS: 3	DATE:	06/18/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:08 PM
MET WITH:	Maria "Alicia" Ortiz, Administrator		TIME COMPLETED:	04:12 PM

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On 06/18/24, Licensing Program Analyst (LPA) L. Salazar arrived to the facility unannounced to conduct the required Annual Inspection Visit. LPA was greeted by Administrator Assistant, stated the purpose of the visit and was allowed entry into the facility.

LPA observed no residents in care at the time of visit as they were all attending day program. Facility is a 4 bedroom 2 bathroom home. There is a designated office to rightof the entry. Bathrooms were observed to have grab bars by the toilets and a grab bar in the shower used by residents. Residents in care receive Regional Center services. Resident bedrooms were observed to have the required lighting and furnishings and were free from odor and free from any passageway obstruction / fire hazards. Facility temperature was 78 degrees F.

LPA toured the facility inside and out and observed the facility temperature read at 75 degrees F. Resident bedrooms were observed to have the required lighting/furnishings and are free from odor and passageway obstruction/fire hazards. Facility bathrooms were observed to have operational lights, running water, and non- slip floors. Hot water temperature tested at 105 degrees F.

Residents' bedrooms were toured and observed to be adequately furnished with bed, dresser, and adequate lighting. A supply of extra linens were observed in the hall closet. Cleaning supplies were observed to be locked in a kitchen cabinet under the sink . LPA toured the kitchen observed the required 7-day supply of non-perishable food and 2- day supply of fresh perishables to be properly stored.

Covered trash cans with lids were observed throughout the facility. Hand washing postings were observed. Carbon monoxide and smoke detectors were observed to be operational. Outside of facility was toured and observed to be clean and free from obstruction. A self-closing and self-latching gate for emergency exit was observed. First aid kits were observed to contain all required items.

Medications were observed to be locked in a cabinet located in the office. Quarterly Emergency Disaster Drill logs were observed for staff.

(Continued on LIC 809-C)

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Lisa Salazar	TELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024

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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: POSITIVE DIRECTIONS #9	FACILITY NUMBER: 157203358
	VISIT DATE: 06/18/2024

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(Continue LIC 809-C)

Required postings were observed for Non-discrimination LGBTQ-A+, Personal Rights of Residents in RCFE (87468.1 and 87468.2), facility's visitation policy and LETUSNO Complaint Poster, (PUB475), Ombudsman poster and Resident Council Rights. No residents are receiving Hospice services residents or receiving Home Health care service. A sample of resident and staff files were reviewed and observed to have the required forms and training records.

The following documents are requested to be updated and submitted to Fresno CCL by: 07/05/24: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Proof of Liability Insurance, Emergency and Disaster Plan (LIC 610E) Personnel Report (LIC500), Register of Facility Clients/Residents (LIC9020A)
An exit interview was conducted with Administrator. A copy of this report will be emailed to Administrator by next business day. No deficiencies cited on today's visit.

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Lisa Salazar	TELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024

LIC809 (FAS) - (06/04)

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