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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247208803
Report Date: 10/22/2021
Date Signed: 10/29/2021 01:47:42 PM

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:WESTSIDE ELDERLY CARE IFACILITY NUMBER:
247208803
ADMINISTRATOR:TOSTADO, MARIA HFACILITY TYPE:
740
ADDRESS:1243 SANTA MARIATELEPHONE:
(209) 827-0142
CITY:LOS BANOSSTATE: CAZIP CODE:
93635
CAPACITY:6CENSUS: 6DATE:
10/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Maria Tostado-LicenseeTIME COMPLETED:
10:45 AM
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On 10/22/2021, Licensing Program Analyst(LPA) D. Ayers arrived at facility unannounced to conduct a Required Annual Inspection. LPA met with Licensee Maria Tostado. Administrator certificate is current with renewal date 7/13/2022.

LPA toured facility inside and out. All passageways and exits were clear and free from obstruction. All smoke detectors and carbon monoxide detector were functional. Facility was adequately furnished and lit. Facility was at a comfortable temperature. LPA observed adequate supply of nonperishable and perishable food stuffs. LPA observed chemicals and hazardous materials to be stored in locked cabinets. Facility had first aid kit which contained all required items. Medication was secured in locked cabinet and appeared to be administered properly.

LPA toured resident bedrooms and bathrooms. All bedrooms were adequately furnished and lit. Bathrooms had secure grab bars and nonskid mats. LPA observed a sufficient supply of extra blankets and linens in hallway cabinets. LPA and Licensee discussed infection control guidelines and best practices. Licensee agreed to provide LPA with LIC 610E and LIC 500 by 11/5/2021. No deficiencies cited during the inspection. Exit interview conducted and a copy of this report provided via email.
SUPERVISOR'S NAME: Andy XiongTELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: David AyersTELEPHONE: (559) 650-7925
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021
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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