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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247208803
Report Date: 09/16/2022
Date Signed: 10/03/2022 10:28:47 AM


Document Has Been Signed on 10/03/2022 10:28 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: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:
09/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Maria Tostado-LicenseeTIME COMPLETED:
10:00 AM
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On 09/16/22, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection - Infection Control. LPA introduced self, stated the purpose of the visit, and meet with Maria Tostado Licensee. All six residents were present during the inspection.

Upon entry facility staff was observed with facial covering. Visitor log-in/temperature check was observed upon entry. Hand sanitizer was readily available to residents and visitors. Facility has one entrance/exit point. Facility appeared cleaned with no obstruction or fire clearance issues. Social distancing is maintained in the common and dining areas. Social distancing and cough etiquette postings observed.

LPA checked residents’ locked medications. LPA observed 30 days PPE supplies. Food supply was checked and appeared to be an adequate supply. Cleaning supplies were stored and locked under kitchen sink and hall cabinets. LPA observed fire extinguisher served date: 10/27/21.

All resident’s room toured and observed to be adequately furnished and lit. LPA observed two shared residents’ bed to be at least 6 feet apart and two single occupant room. All bathrooms are observed with securely fastened grab bars and non-skid mat. Trash bin observed with no lid in bathrooms. Hand washing posting observed by bathroom sinks.

The exterior tour was conducted. Side gate was self-closing and self-latching. Staff records were reviewed for good health and infection control training. All resident records reviewed to have updated emergency contact information.

No deficiencies issued during this inspection.

Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 09/22/22. The following updated forms were requested: Lic 308, Lic 500, Lic 610E, Lic 9282, control of property, and liability insurance. A copy of this report was provided to Licensee.

SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:
DATE: 09/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/16/2022
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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