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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547204082
Report Date: 01/10/2022
Date Signed: 01/10/2022 10:26:14 AM

Document Has Been Signed on 01/10/2022 10:26 AM - 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:ANDRES, RICARDOFACILITY TYPE:
735
ADDRESS:312 NW 4TH STREETTELEPHONE:
(559) 741-1296
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY: 4CENSUS: 4DATE:
01/10/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:09 AM
MET WITH:Administrator Ricardo AndresTIME COMPLETED:
10:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Shawna Doucette contacted the facility to commence a Case Management. LPA completed a facility visit using Covid-19 precautions. LPA identified herself and discussed the purpose of the visit with Administrator Ricardo Andres.

LPA was contacted due to the heater in the facility being inoperable. LPA received a photo of the thermostat showing the facility temperature is at 61 F. LPA contacted the facility via telephone on 1/7/22 to find out the status of the heater. LPA and LPM Sergiy Pidgirny spoke with Administrator Ricardo Andres. LPA asked Administrator how long the facility was without heat. Administrator advised for about two weeks. Administrator stated he contacted a heating company that day for repair. LPA asked Administrator if he reported the issue to Licensing when the heater was known to be broken. Administrator stated he did not report the heater being broken to Licensing.

LPA conducted staff interviews.


Deficiencies are being cited based on LPA observation, interviews conducted, and record review in accordance with the CCR Title 22. See LIC 809D. Civil Penalties were issued for repeat violation.


Exit interview was conducted and a copy of this report was provided via email to Administrator.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2022
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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Document Has Been Signed on 01/10/2022 10:26 AM - It Cannot Be Edited


Created By: Shawna Doucette On 01/10/2022 at 09:15 AM
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: ABARQUEZ HOMES INC.
FACILITY NUMBER: 547204082

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/10/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/14/2022
Section Cited
CCR
80061(b)(1)(D)

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80061 Reporting Requirements (b)…report shall be made to the licensing agency within the agency's next working day… shall be submitted to the licensing agency within seven days ...(1)Events reported shall include the following: (D)Any injury to any client which requires medical treatment. This requirement is not met as evidenced by:
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Plan of Correction POC Licensee agrees to submit a written understanding of this regulation by POC due date 1/14/22
Civil Penalties issued.
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Licensee did not submit an incident report regarding the heater in the facility being broken within the reporting requirements time frame which poses an Immediate Health and Safety Risk to persons in care.
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Type A
01/14/2022
Section Cited
CCR80088(a)(1)

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80088 Furniture, Fixtures, Equipment, and Supplies (a) A comfortable temperature for clients shall be maintained at all areas. (1) The licensee shall maintain the temperature in rooms that clients occupy between a minimum of 68 degrees F (20 degrees C) and a maximum of 85 degrees F (30 degrees C).
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Plan of Correction POC Licensee agrees to have the heater repaired by POC due date and will submit a receipt.
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This requirement was not met as evidenced by Licensee not having a working heater which showed the facility to be 61 F which poses an immediate Health and Safety Risk to persons in care.
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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:Sergiy Pidgirny
LICENSING EVALUATOR NAME:Shawna Doucette
LICENSING EVALUATOR SIGNATURE:
DATE: 01/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/10/2022


LIC809 (FAS) - (06/04)
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