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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 540405565
Report Date: 02/26/2025
Date Signed: 02/26/2025 07:52:19 PM

Document Has Been Signed on 02/26/2025 07:52 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:SUE'S CARE FACILITYFACILITY NUMBER:
540405565
ADMINISTRATOR/
DIRECTOR:		TINA ALAFAFACILITY TYPE:
735
ADDRESS:1616 CASTLEVIEWTELEPHONE:
(559) 739-0712
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY: 6CENSUS: 4DATE:
02/26/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:House Manager (HM) Connie PowellTIME VISIT/
INSPECTION COMPLETED:
08:15 PM
NARRATIVE
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An unannounced Annual visit was conducted by Licensing Program Analyst (LPA) K. McClurg. LPA met with House Manager (HM) Connie Powell LPA introduced self, presented business card, stated purpose of visit, & was allowed entry.

Physical plant tour began in resident bedrooms. Bedrooms sufficiently furnished with adequate lighting. Sufficient supply of linens available. Resident upstairs bathroom toured. Bathroom appeared to be clean with no unpleasant odors. Fixtures operational. Hot water measured @ 124 degrees F.

Living & dining rooms sufficiently furnished with adequate lighting. Kitchen toured. Food supplies appeared to be sufficient to meet 2-day perishable & 7-day non-perishable requirement, plus additional food for snacks & for meals between shopping visits. Freezer side of refrigerator/freezer needs to be defrosted. Food stored at appropriate temperature. Knives locked & inaccessible.

Garage toured. Working appliances in garage: 1 upright refrigerator/freezer & 1 upright freezer. Upright freezer observed to be heavily frosted over & over-full of food. Food packages frosted over as well.


Continued.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE: DATE: 02/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/26/2025
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 4
Document Has Been Signed on 02/26/2025 07:52 PM - It Cannot Be Edited


Created By: Kelly J. McClurg On 02/26/2025 at 06:57 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: SUE'S CARE FACILITY
FACILITY NUMBER: 540405565

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/26/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80087(g)
Building and Grounds
(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.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Side yard observed to have hazardous yard equipment & ladders accessible & not secured in a safe manner. Accessible: 2 ladders, 1 pole saw with blade attached, 1 gas-powered leaf blower. Pole saw & 1 ladder hanging items on bent nails off 2x4 attached to siding of house.
POC Due Date: 02/27/2025
Plan of Correction
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House Manager agreed to have hazardous items stored in a safe manner & inaccessible to clients or removed from property to clear citation. To be corrected by POC due date indicated above. LPA to be notified by email or phone when corrected.
Type A
Section Cited
CCR
80088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Hot water in upstairs resident bathroom tested & measured at 124 degrees F.
POC Due Date: 02/27/2025
Plan of Correction
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House Manager agreed to have hot water adjusted to temperature between 105 & 120 degrees F. To be corrected by POC due date indicated above. LPA to be notified by email or phone when corrected.
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:See Moua
LICENSING EVALUATOR NAME:Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE:
DATE: 02/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/26/2025


LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 02/26/2025 07:52 PM - It Cannot Be Edited


Created By: Kelly J. McClurg On 02/26/2025 at 06:57 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: SUE'S CARE FACILITY
FACILITY NUMBER: 540405565

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/26/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
85076(d)(4)
Food Service
(4) Freezers and refrigerators shall be kept clean, and food storage shall permit the air circulation necessary to maintain the temperatures specified in (2) and (3) above.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations: Upright freezer in garage frosted over & stocked to limit of space available. Freezer requires defrosting & to store less items so as to not prevent air circulation. Freezer portion on inside refrigerator/freezer needs defrosting.
POC Due Date: 03/10/2025
Plan of Correction
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Freezers to be defrosted & have room enought for proper air circulation per regulation. To be corrected by POC due date indicated above. LPA to be notified by due date by email or phone when corrected.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:See Moua
LICENSING EVALUATOR NAME:Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE:
DATE: 02/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/26/2025


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: SUE'S CARE FACILITY
FACILITY NUMBER: 540405565
VISIT DATE: 02/26/2025
NARRATIVE
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Continued.

Outside area toured. Front, entry side, & back yards appeared to be maintained & free of hazardous items or miscellaneous debris. Side yard off of garage observed to have yard & maintenance equipment accessible & not stored in a safe manner. Accessible: 2 ladders, 1 pole saw with blade attached, 1 gas powered leaf blower. Pole saw & 1 ladder hanging on bent nails off wood 2 x 4 attached to siding on side of house.

Facility temperature felt comfortable without being too hot to move about freely & not too cold to require additional layers of clothing. Interior & exterior passageways free & clear of obstructions. Handrail firmly secured to wall along stairs. Smoke & carbon monoxide detectors tested & observed to be operational. Fire extinguisher service date: 1/24/25.

Facility records reviewed. Medications organized & stored in manner making them inaccessible to clients. Medication Centrally Stored Medication & Destruction Record (CSMDR) reviewed & observed to be appropriately maintained.

Deficiencies issued.

Exit interview conducted with HM. Report provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2025
LIC809 (FAS) - (06/04)
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