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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247202970
Report Date: 06/17/2022
Date Signed: 06/17/2022 10:24:21 AM

Document Has Been Signed on 06/17/2022 10:24 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:TORRES ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
247202970
ADMINISTRATOR:TORRES, MARIVIC T.FACILITY TYPE:
735
ADDRESS:2905 SOQUEL AVENUETELEPHONE:
(209) 769-4620
CITY:ATWATERSTATE: CAZIP CODE:
95301
CAPACITY: 3CENSUS: 2DATE:
06/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:16 AM
MET WITH:Licensee, Marivic Torres and Licensee Gabriel TorresTIME COMPLETED:
10:30 AM
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On 06/17/2022, Licensing Program Analyst (LPA) A. Walton arrived unannounced to conduct an Annual Inspection - Infection Control. LPA introduced self, stated the purpose of the visit and was granted entry to the facility. LPA met with Licensees Marivic and Gabriel Torres. Facility has one central entry and exit. Visitor log/Screening log observed at the entrance. There are no residents present during this inspection.

LPA conducted a facility tour with Licensees. Facility appeared clean and odor free. Facility is cleaned and sanitized throughout the day. Resident bathroom is stocked with paper towels and liquid soap. Hand-washing signs observed by bathroom sinks. LPA observed signs promoting hand-washing, social distancing, and cough/sneeze etiquette throughout the facility. Bedrooms are single occupant at this time.

LPA observed the PPE and cleaning supplies. LPA observed an adequate supply of food. Medications checked. Facility receives a supply of medications each month. Resident records were reviewed.

LPA is requesting the following documents be submitted to the Fresno CCL office by 07/01/2022: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Emergency and Disaster Plan (LIC610D), Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020), and Surety Bond


No deficiencies issued during this inspection. An exit interview was conducted with Licensees. A copy of this report was discussed and provided to Licensee, Marivic Torres, whose signature on this form confirms receiving this document.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 06/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2022
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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