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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547204100
Report Date: 04/14/2022
Date Signed: 04/14/2022 02:21:37 PM

Document Has Been Signed on 04/14/2022 02:21 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:AGDA RESIDENTIAL CARE HOMEFACILITY NUMBER:
547204100
ADMINISTRATOR:AGDA, CHRISTOPHERFACILITY TYPE:
735
ADDRESS:1846 PAMELA AVENUETELEPHONE:
(559) 788-0696
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY: 6CENSUS: 4DATE:
04/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:57 AM
MET WITH:Dessirae PinheiroTIME COMPLETED:
01:58 PM
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On 04/14/2022, Licensing Program Analyst (LPA) M. Medina arrived at the above facility unannounced to conduct an Infection Control Inspection. LPA was allowed entrance by Direct Care Staff, Dessirae Pinheiro. Licensee Christopher Agda was contacted by telephone and not available to conduct today's inspection.

Facility appeared cleaned with no obstruction or fire clearance issues. Hand sanitizer was available to residents and visitors. Social distancing is maintained in the common and dining areas. Bathrooms were stocked with paper towels and liquid soap. Hand washing posters observed in the kitchen area and near the bathroom sink. Resident bedrooms with double occupancy observed to have beds 6 feet apart. LPA observed carbon monoxide and smoke detectors observed to be operational during today's inspection. Fire extinguisher present with a purchase date of 1/20/2022.



LPAs checked residents’ locked medications. Food supply was checked and there appeared to be an adequate food available for the residents in care. Cleaning and PPE supplies were checked, all items are locked and secured and inaccessible to residents.

No deficiencies were observed. Exit interview conducted.

Administrator informed that as a COVID-19 precautionary measure, a copy of this report will be provided via email.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 04/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/14/2022
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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