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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547202486
Report Date: 07/26/2022
Date Signed: 07/26/2022 01:00:08 PM

Document Has Been Signed on 07/26/2022 01:00 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:JEFFRIES HOME 2FACILITY NUMBER:
547202486
ADMINISTRATOR:JEFFRIES, JENNIFERFACILITY TYPE:
735
ADDRESS:1220 LOTAS WAYTELEPHONE:
(559) 783-8639
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY: 6CENSUS: 6DATE:
07/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:28 AM
MET WITH:Jennifer JeffriesTIME COMPLETED:
01:15 PM
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On 7/26/22, Licensing Program Analyst (LPAs) M. Medina and V. Gorban conducted an unannounced Annual Required Infection Control inspection. LPAs allowed entrance by Licensee, Jennifer Jeffries. LPAs observed COVID-19 precautions at entry, visitor sign in sheets, hand sanitizer, and temperature checks. All staff and visitors utilize front door as main entry.

LPAs toured facility inside and out. All bedrooms are shared with a minimum of 6 feet between beds. Bathrooms toured, bathroom have adequate supply of hand soap and paper towels available. Hand washing posters observed by the bathroom sink. Social distancing is maintained in the common and dining areas. Hand washing posters observed by the bathroom sink.

LPAs observed resident's medication to be locked and secured, all residents have a 30-day of medication available. LPAs observed facility to have a 2-day supply of perishable and 7-day of non-perishable food available. Cleaning supplies are locked and secured in laundry area. Personal Protective Equipment (PPE) observed to be available if required.

Smoke detectors and carbon monoxide detectors observed to be operational during today's inspection. Fire extinguisher present with a service date of 1/19/22.

Outside toured, no obstructions observed. Facility pool has a 6 foot perimeter fence that is locked and secured and inaccessible to residents.

No deficiencies observed. Exit interview conducted. Facility report signed and a copy for facility records.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2022
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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