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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247202427
Report Date: 03/29/2022
Date Signed: 04/28/2022 03:53:33 PM


Document Has Been Signed on 04/28/2022 03:53 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:TERRIE'S TLC SENIOR HOME IIFACILITY NUMBER:
247202427
ADMINISTRATOR:RHODES, THERESE ANNEFACILITY TYPE:
740
ADDRESS:1317 E BROOKDALE DR.TELEPHONE:
(209) 726-0548
CITY:MERCEDSTATE: CAZIP CODE:
95340
CAPACITY:6CENSUS: 0DATE:
03/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Administrator, Therese RhodesTIME COMPLETED:
12:33 PM
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On 3/29/2022 Licensing Program Analysts (LPA's) M. Garza and K. Kaur arrived at facility to complete an unannounced Infection Control/Annual visit. LPA's contacted facility Administrator who arrived at facility a short time later and permitted entry into facility.

Facility was recently under remodel and at this time the facility does not have any residents or staff.

Mitigation plan was received and reviewed. COVID-19 procedures described in the plan include required postings, symptoms screenings (for staff, persons in care and visitors), testing, quarantine/isolation cohorts, infection control plan to include donning and doffing of Personal Protective Equipment. Staffing and sick leave plans are in place for emergency staffing and/or PPE shortages.

LPA's toured the facility inside and out. Required postings of signs to include hand washing and physical distancing were observed. Coughing/sneezing etiquette was not present. Facility has designated visitation areas. A supply of PPE was available but Administrator to provide additional PPE for staff. Sinks are well stocked and liquid soap for hand washing and paper towels for hand drying were observed.

Through LPA's observation of documentation and interview with Administrator the required infection control practices are found to be in compliance. No deficiencies cited on todays inspection.

Due to COVID precautionary measures a copy of this will be emailed to: Rhodesbuds@yahoo.com. A delivered an read receipt serves as confirmation of receipt.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Mary GarzaTELEPHONE: (559) 365-9009
LICENSING EVALUATOR SIGNATURE:
DATE: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/29/2022
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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