<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 167204056
Report Date: 12/14/2021
Date Signed: 12/14/2021 01:44:30 PM

Document Has Been Signed on 12/14/2021 01:44 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:LEMOORE ADULT DAYFACILITY NUMBER:
167204056
ADMINISTRATOR:WARTSON, BOBBIEFACILITY TYPE:
775
ADDRESS:1075 BLAKE STREETTELEPHONE:
(559) 924-4419
CITY:LEMOORESTATE: CAZIP CODE:
93245
CAPACITY: 15CENSUS: 9DATE:
12/14/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Pam Chin,Program Director/AdministratorTIME COMPLETED:
10:45 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) M. Yang conducted an unannounced Required Annual Inspection- Infection Control. LPA introduced self, stated the purpose of the visit, and met with Program Director/Administrator Pamela (Pam) Chin. Four clients present during tour. Clients were observed watching reading and playing their electronics. LPA conducted a complete tour, inside and out, with the Administrator.

Upon entry staffs was observed not wearing facial covering.No visitor log-in/temperature check was observed upon entry. Hand sanitizer was readily available to clients and visitors. Facility has one entrance/exit point. Facility appeared cleaned with no obstruction or fire clearance issues. Client restroom observed to be clean and operational. Hand washing posting by bathroom sink. Social distancing is maintained in the facility. Social distancing and cough etiquette postings not observed.

Clients are provided lunch that is prepared on site in facility kitchen. Chemicals are stored in a locked cabinet in the kitchen. Currently there is 2 clients in care that is given medication when they are at the facility. Medications are stored in a locked cabinet in the kitchen. LPA observed a locked shed containing paper supplies. Facility 30 day PPE supply is stored at program main office.

Fire extinguisher has a service date of 08/17/21. Last fire drill was on 11/30/21. Staff records were reviewed for good health and infection control training. A sample of clients’ records reviewed to have updated emergency contact information.

No deficiency was observed. Exit Interview conducted.

Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 12/20/21. The following updated forms were requested: Lic 308, Lic 309, Lic 500, and Lic 9020. LPA received copy of Lic 610D during inspection. Administrator was informed that as COVID-19 precautionary measure, this report will be provided via email. Report signed on-site.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 12/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1