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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547203462
Report Date: 10/14/2022
Date Signed: 10/14/2022 12:35:24 PM

Document Has Been Signed on 10/14/2022 12:35 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:RICO RESIDENTIAL FACILITY #1FACILITY NUMBER:
547203462
ADMINISTRATOR:RICO, DIANAFACILITY TYPE:
735
ADDRESS:381 N. YORK ST.TELEPHONE:
(559) 782-0311
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY: 6CENSUS: 4DATE:
10/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:27 AM
MET WITH:Brianna ReyesTIME COMPLETED:
11:45 AM
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On this date 10/14/22, Licensing Program Analyst (LPA) Medina conducted an Annual Required Inspection. LPA was met by Co-Administrator, Brianna Reyes. LPA stated purpose of visit and allowed entrance. All COVID-19 guidelines observed to be in place.

Facility toured. All common areas have adequate seating for residents. Resident bedrooms observed to have required furnishings, 2 bedrooms are private, 2 shared rooms with a minimum of 6 feet between beds. Kitchen toured, facility observed to have 2-day supply of perishable food and a 7-day supply of non-perishable food available. Medication observed to be locked and secured in cabinet near kitchen. All residents have a 30-day supply of medication available.

Fire extinguisher present and has a service date of 11/3/2021. Carbon monoxide detector and smoke detectors present and observed operational during today's inspection.

All cleaning supplies are locked and secured in garage cabinet.

Outside toured, all fire exits are free of obstruction.

No deficiencies were observed. Exit interview was conducted. Report signed during inspection and a copy left for facility file.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/14/2022
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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