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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 167206688
Report Date: 05/17/2022
Date Signed: 05/17/2022 12:04:05 PM

Document Has Been Signed on 05/17/2022 12:04 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:KINGS REHABILITATION CENTER, INC.-DTACFACILITY NUMBER:
167206688
ADMINISTRATOR:ACOSTA, SUSANFACILITY TYPE:
775
ADDRESS:488 E. HANFORD ARMONA RDTELEPHONE:
(559) 583-5051
CITY:HANFORDSTATE: CAZIP CODE:
93230
CAPACITY: 120CENSUS: 82DATE:
05/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH: Stephanie Sanchez-Program ManagerTIME COMPLETED:
12:00 PM
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On 05/17/2022, Licensing Program Analyst (LPA) K.Kaur arrived unannounced to conduct an Annual Inspection - Infection Control. LPA introduced self, stated the purpose of the visit, and met with Stephanie Sanchez-Program Manager. 25 clients were present during the inspection.

Visitor log-in/temperature check was observed upon entry. Staff observed with facial coverings. Hand sanitizer was readily available to clients and visitors. Fire extinguishers were observed with a service date of: 04/19/22. Hand washing and other various Covid-19 related signs were observed in the common areas.

LPA toured the facility inside and outside. All passageways and exits were clear and free from obstruction. Facility was at a comfortable temperature and well lit. All classrooms and activity areas were clean and odor free. Bathrooms were clean and fixtures were functioning properly. LPA observed multiple first-aid kits throughout the facility.

Facility dining area toured and appeared clean and is being used a open classroom to follow social distancing guidelines. Clients bring their own lunches to program. Lunches stored in refrigerator in facility kitchen. LPA observed 30-day PPE supply.

No deficiencies were observed.

Exit Interview conducted. The following documents are requested and need to be submitted to Fresno CCL by:5/24/22. LIC308, LIC309, LIC500, LIC610D, and LIC9020.

An exit interview was conducted. Report signed on-site by Manager and a printed copy was provided.
SUPERVISORS NAME: Brenda White
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2022
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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