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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547204082
Report Date: 08/06/2024
Date Signed: 08/07/2024 01:26:25 PM

Document Has Been Signed on 08/07/2024 01:26 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:ABARQUEZ HOMES INC.FACILITY NUMBER:
547204082
ADMINISTRATOR/
DIRECTOR:		ANDRES, RICARDOFACILITY TYPE:
735
ADDRESS:312 NW 4TH STREETTELEPHONE:
(559) 741-1296
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY: 4CENSUS: 3DATE:
08/06/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Ricardo Andres, AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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On 08/06/24, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to conduct a Health and Safety inspection. LPA was greeted by Administrator, stated the purpose of the visit and was allowed entry into the facility.

LPA toured the facility inside and out. LPA observed 3 residents in care with 3 staff and Administrator present at the time of visit. All residents in care have 1:1 on staffing. LPA observed food supply to be adequate. Temperature in the home was 72 degrees.

LPA obtained the following information from the Administrator for Resident R1.
Individual Performance Plan (IPP); Centrally Strored Medication Destruction Record (CSMDR); Medication Administration Record (MARS); Urgent Care discharge papers; Hospital Discharge papers; Admission Agreement and documentation provided to facility at the time if admission in April 2024.

LPA will review information and return at a later date. No deficiencies cited on today's visit. A copy of this report will be emailed by next business day.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 08/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/06/2024
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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