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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547201564
Report Date: 04/07/2021
Date Signed: 04/26/2021 04:45:28 PM

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:LOVING CARE ASSISTED LIVINGFACILITY NUMBER:
547201564
ADMINISTRATOR:PERRY, FEFACILITY TYPE:
740
ADDRESS:1542 E. GLENWOOD AVENUETELEPHONE:
(559) 688-4835
CITY:TULARESTATE: CAZIP CODE:
93274
CAPACITY:6CENSUS: 3DATE:
04/07/2021
TYPE OF VISIT:Case Management - Legal/Non-complianceANNOUNCEDTIME BEGAN:
01:03 PM
MET WITH:Licensee Ronald PerryTIME COMPLETED:
01:40 PM
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Licensing Program Analyst (LPA) Lady Cabrera conducted a Case Management visit for the purpose of Health and Safety visit for the Residents in care via FaceTime due to COVID-19 and pre-cautionary measures. A tour inside and outside the facility was conducted.

LPA toured the facility. The residence was free of passageway obstructions inside and outside. Kitchen toured, a 2-day supply of perishable and 7-day supply of nonperishable food was present. Medications, cleaning supplies and sharp/knives are locked in kitchen cabinets. Rooms were found to be clean.

Fire Drill completed on 4/4/2021. Smoke detectors and carbon monoxide detectors were checked and operating. A Fire extinguisher is present with a 09/2020 service date. The home is equipped with fire sprinklers.

There are currently 2 Residents receiving hospice services.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Lady CabreraTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2021
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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