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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 540405565
Report Date: 02/09/2023
Date Signed: 02/09/2023 09:39:36 AM

Document Has Been Signed on 02/09/2023 09:39 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:SUE'S CARE FACILITYFACILITY NUMBER:
540405565
ADMINISTRATOR:TINA ALAFAFACILITY TYPE:
735
ADDRESS:1616 CASTLEVIEWTELEPHONE:
(559) 739-0712
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY: 6CENSUS: 4DATE:
02/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:43 AM
MET WITH:House Manger Connie PowellTIME COMPLETED:
09:50 AM
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On 02/9/23, Licensing Program Analyst (LPA) Yang arrived unannounced and to conduct an Annual Inspection- Infection Control. LPA was greeted by House Manger (HM) Connie Powell. LPA introduced self, stated the purpose of the visit, and was granted entry. There are no client present during inspection. LPA toured the facility with HM.

Upon entry facility staff was observed with facial mask. No Visitor log-in/temperature check was observed upon entry. Hand sanitizer was available to clients and visitors. Facility has one entrance/exit point. Facility appeared cleaned with no obstruction. Social distancing is maintained in the common and dining areas. LPA observed cough etiquette posting in facility. LPA observed fire extinguisher served date: 01/17/23. Cleaning chemicals stored and locked in garage cabinet.

Food supply was checked and appeared to be an adequate supply. All clients’ room toured and observed to be adequately furnished and lit. LPA observed 1 shared bedroom beds appeared to be 6 feet apart and 2 bedroom that are single occupant. Bathroom observed trash bin with lid. LPA observed hand washing posting by bathroom sink. LPA observed a small amount of PPE supplies which included: N95, surgical mask, face shields, and gloves.

The exterior tour was conducted. Side gate clear from debris. All client records reviewed to have updated emergency contact information. Staff records were reviewed for good health and have current First Aid/ CPR.

No deficiencies issued during this inspection.

Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 2/15/23. The following updated forms were requested: Lic 308, Lic 309 (if applicable), Lic 400, Lic 402, Lic 500, Lic 610D, Lic 808, Lic 9020, and Lic 9282. LPA received copy of current Administrator certificate. A copy of this report was provided to the HM.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/09/2023
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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