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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 167202502
Report Date: 07/14/2022
Date Signed: 07/14/2022 02:47:18 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/08/2022 and conducted by Evaluator Kamaldeep Kaur
COMPLAINT CONTROL NUMBER: 24-AS-20220708141810
FACILITY NAME:HANNA'S HOME CAREFACILITY NUMBER:
167202502
ADMINISTRATOR:FELLEKE, HANNAFACILITY TYPE:
740
ADDRESS:2427 CHERRYWOOD CT.TELEPHONE:
(559) 583-6880
CITY:HANFORDSTATE: CAZIP CODE:
93230
CAPACITY:6CENSUS: 1DATE:
07/14/2022
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Administrator Hanna Felleke TIME COMPLETED:
02:50 PM
ALLEGATION(S):
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Facility has mold
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) K. Kaur arrived at the facility unannounced to conduct an initial 10-day complaint inspection. LPA discussed the purpose of the visit and the elements of the allegations with the Licensee Hanna Felleke.

LPA conducted a tour of the facility and observed standing water in the kitchen sink. LPA observed water damage to the cabinetry under the sink and what appeared to be dark mold like substance. LPA interviewed Administrator and was informed the kitchen disposal was not working which may have caused the water leak.

The preponderance of evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED. See citations on the attached LIC9099D. Plan of Corrections were reviewed and developed with the Licensee. Exit interview was conducted and appeal rights were provided.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) 580-4596
LICENSING EVALUATOR NAME: Kamaldeep KaurTELEPHONE: (559) 341-7449
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 24-AS-20220708141810
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: HANNA'S HOME CARE
FACILITY NUMBER: 167202502
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/22/2022
Section Cited
CCR
80087(a)
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80087(a) Buildings and Grounds. (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
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Licensee contacted a plumber and scheduled repair of Light switch/ Disposable for today, 7/14/22. Licensee will schedule for cabinets under kitchen sink to be replaced.
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LPA observed water damage to the cabinetry under the sink and what appeared to be dark mold like substance due to kitchen disposal to be damaged or not operating.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) 580-4596
LICENSING EVALUATOR NAME: Kamaldeep KaurTELEPHONE: (559) 341-7449
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2