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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 207206295
Report Date: 08/29/2022
Date Signed: 09/01/2022 10:05:57 AM

Document Has Been Signed on 09/01/2022 10:05 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:CORONADO ARFFACILITY NUMBER:
207206295
ADMINISTRATOR:CORONADO, KATHYFACILITY TYPE:
735
ADDRESS:25606 MARTIN STREETTELEPHONE:
(559) 660-5324
CITY:MADERASTATE: CAZIP CODE:
93638
CAPACITY: 6CENSUS: 6DATE:
08/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:42 PM
MET WITH:Administrator Rikki RaymondTIME COMPLETED:
04:48 PM
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On 08/29//22, Licensing Program Analysts (LPA) M. Garza and B. Miranda arrived at the facility unannounced to conduct an Infection Control/Annual Inspection. LPAs were greeted by Administrator, Rikki Raymond. LPAs stated the purpose of the visit and was allowed entry into the facility. LPAs was not COVID pre-screened upon entry. LPAs entered through a central entry point and did not observe a screening sign-sheet or PPE precautionary measures in place. Administrator Kathy was contacted via phone and authorized Rikki to conduct inspection with LPAs.

LPAs toured the facility and completed a health and safety check on clients in care. Clients observed in rooms and common areas allowing social distancing. Infection control postings were observed. Furniture in common areas are spaced to promote distancing. A supply of PPE is located in the garage. Hand washing postings were observed at hand washing stations.

Fire Extinguisher was purchased 6/22/2022. LPAs observed a first aid kit with all the required items. LPAs requested the following updated forms by 09/02/22: LIC 308, LIC 309, LIC 500, LIC 610D, and LIC 9020.

TA provided for infection control issues listed above. Exit interview completed with Administrator, Rikki Raymond. A copy of this report given.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2022
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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