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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209045
Report Date: 08/23/2021
Date Signed: 08/24/2021 11:17:19 AM

Document Has Been Signed on 08/24/2021 11:17 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:SVS DELANOFACILITY NUMBER:
157209045
ADMINISTRATOR:COPELAND, SUZANNEFACILITY TYPE:
775
ADDRESS:1323 MAIN ST.TELEPHONE:
(559) 443-7119
CITY:DELANOSTATE: CAZIP CODE:
93215
CAPACITY: 30CENSUS: 2DATE:
08/23/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Sam Pedroza, Program Director TIME COMPLETED:
03:00 PM
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On this day, Licensing Program Analyst (LPA) L. Salazar arrived at the Day Program unannounced to conduct the Infection Control Inspection. LPA met with Program Director, Sam Pedroza. LPA completed the Covid-19 Contact questionnaire prior to entrance into the facility.

Upon entry, LPA’s temperature and symptom screening was conducted by staff. LPA entered through the central entry point where hand sanitizer, visitor sign in and screening policy was observed.

Facility Mitigation plan has been approved. 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, staffing plan, Personal Protection Equipment (PPE) storage and use, infection control training, communication procedures. Program Director, Sam Pedroza is identified as the Infection Control Lead for the program.

LPA toured the facility inside and out. Required postings such as hand washing, coughing etiquette and physical distancing were observed in the facility. Staff were all observed wearing face coverings. Social Distancing interventions such as floor markers and individual work stations were observed. LPAs observed 30-day PPE supply. Sinks observed to be stocked with liquid soap, paper towels and covered trash cans in restrooms.
Through LPA’s observations and interview with Program Director, the required infection control practices are found to be in compliance. No deficiencies cited on today’s inspection.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2021
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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