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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206247
Report Date: 09/14/2023
Date Signed: 09/14/2023 01:13:12 PM

Document Has Been Signed on 09/14/2023 01:13 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:PTS THREEFACILITY NUMBER:
157206247
ADMINISTRATOR:RAYA,LUISFACILITY TYPE:
735
ADDRESS:11113 SONOMA CREEK CTTELEPHONE:
(661) 679-4138
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY: 4CENSUS: 2DATE:
09/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:07 AM
MET WITH:Luis RayaTIME COMPLETED:
01:23 PM
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Licensing Program Analysts (LPAs) M. Flores and M. Medina arrived at the facility unannounced to conduct a required annual visit. LPAs explained the purpose of this visit and conducted a tour of the home with Administrator (AD), Luis Raya.

The residence was set at 73 F temperature and free of passageway obstructions inside and outside. LPAs observed four bedrooms in the residence. Residents' rooms were toured and inspected. Rooms were found to be clean. Hot water temperature was measured at 109 F.

Kitchen toured, food supply observed to be adequate for residents in care, all food observed to be properly stored and dated. Knives were stored and secured in hallway closet. Medications observed to be locked and secured and administered as prescribed. Cleaning supplies were locked and stored in the garage. Smoke detectors and carbon monoxide detectors observed to be operational during facility inspection. Fire extinguishers have a service date of 3/20/23. Fire drill was last completed on 8/29/23.

Outside of facility toured, all exits are free of obstruction and no hazards observed.

Resident’s files, medication and staff records were reviewed. Current first aid and CPR were on file for staff.

Administrator to submit an updated LIC9020, LIC500, Administrator certificate and current CPR to Fresno Regional Office no later than 9/22/23.

An exit interview was conducted with the Administrator. A copy of this report was provided to Administrator.

No deficiencies observed during inspection visit.

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Miriam Flores
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2023
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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