<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202228
Report Date: 03/06/2024
Date Signed: 03/06/2024 05:02:37 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 03/06/2024 05:02 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
FRESNO ASC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:PLATINUM CAREFACILITY NUMBER:
275202228
ADMINISTRATOR:MILA GREENFACILITY TYPE:
735
ADDRESS:1430 COUGAR DRIVETELEPHONE:
(831) 229-0522
CITY:SALINASSTATE: CAZIP CODE:
93905
CAPACITY: 6CENSUS: 4DATE:
03/06/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Licensee, Mila GreenTIME COMPLETED:
05:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with Mila Green, Continual Administrator's Certification expired 12/21/2023 is listed as pending on the Social Services website. There are currently 4 residents currently living in this home. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, activity rooms, medication storage, kitchen, garage and outdoor areas. There is a locked storage for medications. Food supply is adequate for 2-day perishable and 7-day nonperishable. Licensee toured facility upstairs bedroom with cell phone via face time as Resident was not allowing in bedroom or upstairs area of facility.

LPA Hurt reviewed facility staff, and resident files on visit 11/09/2023.

LPA Hurt observed food inside refrigerator with no labels or dates. LPA Hurt observed kitchen bar stool furniture ripped, and facility side fence is in disrepair. Toxins and cleaning supplies are in an area in the garage open and accessible to residents.

The following deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22.

Exit interview conducted with Mila Green, and copy of report left at facility
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 03/06/2024 05:02 PM - It Cannot Be Edited


Created By: Sarah Hurt On 03/06/2024 at 04:34 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: PLATINUM CARE
FACILITY NUMBER: 275202228

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/20/2024
Section Cited
CCR
80087(a)

1
2
3
4
5
6
7
80087 Buildings and Grounds(a)The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. The following requirement has not been met as evidenced by:
1
2
3
4
5
6
7
Licensee will replace broken bar stool chairs, window screens, repair broken fence, and send proof to LPA by POC date of 03/20/2024.
8
9
10
11
12
13
14
LPA observed the facility barstools are ripped and in disrepair, the facility back fence is in disrepair, which poses a potential, health, safety, or personal rights risk to residents in care.
8
9
10
11
12
13
14
Type B
03/20/2024
Section Cited
CCR80887(a)(g)

1
2
3
4
5
6
7
80087 Buildings and Grounds (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.
(g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients. The following requirement has not been met as evidenced by:
1
2
3
4
5
6
7
Licensee will ensure toxins, and chemicals are locked away and inaccesible to residents in care, and send proof to LPA by POC date of 03/20/2024.
8
9
10
11
12
13
14
LPA Hurt observed the facility garage unlocked with chemical and toxins accesible to residents, which poses a potential health, safety, or personal rights risk to residents care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Brenda Chan
LICENSING EVALUATOR NAME:Sarah Hurt
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2024


LIC809 (FAS) - (06/04)
Page: 2 of 2