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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 207202624
Report Date: 04/05/2022
Date Signed: 04/05/2022 02:32:09 PM

Document Has Been Signed on 04/05/2022 02:32 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:FARR'S FAMILY FACILITY-ELDERLYFACILITY NUMBER:
207202624
ADMINISTRATOR:FARR, GENEVAFACILITY TYPE:
740
ADDRESS:104 SASSAFRAS DRIVETELEPHONE:
(559) 661-4275
CITY:MADERASTATE: CAZIP CODE:
93637
CAPACITY: 6CENSUS: 3DATE:
04/05/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Licensee Geneva Farr, TIME COMPLETED:
02:45 PM
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On 04/05/2022 Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to conduct a Plan of Correction (POC) inspection. LPA was greeted by Staff S1, stated the purpose of the visit and was allowed entry in the facility. LPA toured the facility inside and out.
LPA observed the kitchen cabinets to be repainted and repaired. S1 provided LPA with grocery receipt in the amount of $197.40 dated 04/04/2022. LPA observed this weeks menu. S1 agrees to continue to send weekly menus and bi-weekly grocery receipts until further notice.
Resident R1 is being relocated to the back bedroom, where a larger, newer is located for their comfort. The larger bedroom also allows more mobility for R1 to use their assisted device (walker).
LPA observed bathroom lights to be repaired and in working condition. Fan next to light was cleaned. Toilet has been cleaned. The doors and vents in the hallway have been cleaned. The door leading to the backyard has been cleaned and free from spider webs.
Pool has been treated with chemicals and the dark green color is gone. S1 will continue to add chemicals to clean and possibly call the City to obtain permit to drain the pool. Debris was located in a universal pile ready to be loaded and dumped.
Licensee contacted The Arc day program, and was told by day program that the program is at full capacity and residents would not be able to return for a couple of weeks.. In the meantime, the facility will provide daily outings to the park and/or restaurants. LPA observed 2 board games. The facility stated they will purchase additional games, writing and coloring supplies for activities for the residents in care.
Exit interview conducted.


SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 04/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/05/2022
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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