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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547204100
Report Date: 11/21/2023
Date Signed: 11/21/2023 02:49:13 PM

Document Has Been Signed on 11/21/2023 02:49 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:
11/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:37 PM
MET WITH:Dessirae PinheiroTIME COMPLETED:
03:08 PM
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On 11/21/23, Licensing Program Analyst (LPA) M. Medina made an unannounced Annual Required inspection. LPA introduced self, stated purpose of visit, and allowed entrance by House Manager, Dessirae Pinheiro. Licensee/Administrator, Christopher Agda contacted by telephone and not available to conduct today's inspection.

Currently, 4 residents in care. Residents attend day program Monday through Friday from 7:00 am - 3:30 pm.

Facility tour conducted both inside and outside. Facility observed to be a comfortable temperature, and in good repair. Residents bedrooms have all required accommodations. Facility has 1 shared and 2 private bedrooms. Living room and dining room areas have adequate seating and lighting for all residents in care. Client bathroom toured, water temperature measured at 109 degrees F in bathroom. Kitchen toured, LPA observed a 2-day supply of perishable and a 7-day non-perishable food available. Medications observed to be locked and secured in medication cart in the kitchen. All medications observed to have original labels, and to be administered as prescribed. Fire extinguisher with a purchase date of 1/05/23, smoke detectors and carbon monoxide detectors observed operational during today's inspection.

Outside tour of facility conducted. All fire exits open freely and are free of obstruction. No hazards observed.

LPA conducted interviewed staff and reviewed files during inspection.

No deficiencies cited during today's inspection.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2023
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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