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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247208957
Report Date: 08/11/2022
Date Signed: 08/11/2022 09:19:04 AM

Document Has Been Signed on 08/11/2022 09:19 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 FACILITY 2FACILITY NUMBER:
247208957
ADMINISTRATOR:TORRES, GABRIELFACILITY TYPE:
735
ADDRESS:1951 MONUMENT COURTTELEPHONE:
(209) 769-4620
CITY:ATWATERSTATE: CAZIP CODE:
95301
CAPACITY: 4CENSUS: 4DATE:
08/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Administrator, Gabriel TorresTIME COMPLETED:
09:27 AM
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On 08/11/2022, Licensing Program Analyst (LPA) Walton arrived unannounced at the above facility to conduct an annual inspection. LPA introduced self, stated the purpose of the visit and met with Administrator, Gabriel Torres.

LPA conducted a facility tour with Administrator. Facility appeared clean and odor free. Facility is cleaned and sanitized throughout the day. Resident bathrooms checked. 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.

LPA observed an adequate supply of PPE and cleaning supplies. Food supply was checked. Medications checked. Facility staff will reorder medication refills and staff will pick up medications each month. Resident records were reviewed. Staff records were reviewed for good health.

LPA is requesting the following documents be submitted to the Fresno CCL office by 08/25/2022: 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 today's inspection. LPA conducted an exit interview with Administrator. A copy of this report was discussed and provided to Administrator, Gabriel Torres, whose signature on this form confirms receipt of this document.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/11/2022
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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