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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547204148
Report Date: 05/27/2022
Date Signed: 05/27/2022 03:23:09 PM

Document Has Been Signed on 05/27/2022 03:23 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:DIAZ OAK VIEW HOMEFACILITY NUMBER:
547204148
ADMINISTRATOR:DIAZ, MARIETTAFACILITY TYPE:
735
ADDRESS:144 W. OAK VIEW DRTELEPHONE:
(559) 741-1002
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY: 6CENSUS: 4DATE:
05/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Avelina Sanlitan, designated representative and Administrator Marietta Diaz via telephoneTIME COMPLETED:
03:45 PM
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On 05/27/22, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection - Infection Control. LPA introduced self, stated the purpose of the visit, and requested to meet with Administrator. LPA met with Avelina Sanlitan, designated representative (designee). Administrator Marietta Diaz was called and unable to attend inspection. LPA conducted a facility tour with designee. All four clients present during tour.

Upon entry facility staffs was observed with no facial covering. Visitor log-in/temperature check was observed upon entry. Hand sanitizer was readily available to clients and visitors. Facility has one entrance/exit point. Facility appeared cleaned with no obstruction or fire clearance issues. Social distancing is maintained in the common and dining areas. LPA observed social distancing and cough etiquette postings in facility.

Food supply was checked and appeared to be an adequate supply. Cleaning supplies were stored and locked under kitchen sink. LPA observed fire extinguisher served date: 07/13/21.

All clients’ room toured and observed to be adequately furnished and lit. LPA observed one shared residents’ bed to be at least 6 feet apart and two single occupant room. All bathrooms observed trash bin with lid. LPA observed hand washing posting by all sinks. LPA checked clients’ locked medications. LPA observed a small amount of 30-day PPE supplies.

The exterior tour was conducted. Side gate was self-closing and free of obstruction. Staff records were reviewed for good health and infection control training. All clients’ records reviewed to have updated emergency contact information.

No deficiencies issued during this inspection.

Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 06/03/22. The following updated forms were requested: Lic 309, Lic 400, Lic 402 and Lic 610E. LPA received copy of facility sketch, current Administrator certificate, Lic 308, Lic 500, Lic 9020 during facility inspection.

A copy of this report was provided to the designee.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 05/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/27/2022
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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