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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547204239
Report Date: 08/16/2021
Date Signed: 08/16/2021 11:04:55 AM

Document Has Been Signed on 08/16/2021 11:04 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:ORDUNO COUNTRY HOMEFACILITY NUMBER:
547204239
ADMINISTRATOR:ORDUNO, CAROLYNFACILITY TYPE:
735
ADDRESS:11600 S. ORANGE BELT DRIVETELEPHONE:
(559) 361-1692
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY: 6CENSUS: 4DATE:
08/16/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:23 AM
MET WITH:Carolyn Orduno
Laura Orduno		TIME COMPLETED:
11:11 AM
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LPA was met by Licensees, Carol Orduno and Laura Orduno and stated the purpose of the visit. A tour of the facility was conducted, COVID-19 guidelines are in place. Visitor log-in/temperature check was observed upon entry at facility entrance/exit point, all staff and visitors enter through side front door .

Facility appeared clean with no obstruction or fire clearance issues. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common and dining areas. Bathrooms have trash cans with lid. Hand washing posters were observed by the bathroom sink. Resident bedrooms are all private.

Fire extinguisher present and has a service date of 09/29/2020. Carbon monoxide detector present and observed to be operational during today's inspection. Water temperature measured at 106 degrees F.

LPA checked residents' medications and checked residents’ medications and observed a 30-day supply. Food supply was checked and there appeared to be an adequate supply. Cleaning and PPE supplies were checked. Facility staff was observed with mask on. Mitigation plan submitted and uploaded to Department on 7/29/2021. Laura Orduno serves as facility Administrator certification #6006764735, expires 7/28/2023. CPR/First Aid expires 2/17/2022.

No deficiencies were observed. Exit interview was conducted. Administrator was informed that as a COVID-19 precautionary measure, this report will be emailed.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 08/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2021
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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