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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547206282
Report Date: 05/17/2022
Date Signed: 05/17/2022 03:07:57 PM

Document Has Been Signed on 05/17/2022 03:07 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:PIRA HOME CAREFACILITY NUMBER:
547206282
ADMINISTRATOR:PIRA, JOSE A, JR.FACILITY TYPE:
735
ADDRESS:4222 S. ROVA STTELEPHONE:
(559) 739-7030
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY: 4CENSUS: 4DATE:
05/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:06 PM
MET WITH:Licensee Jose Pira Jr.TIME COMPLETED:
03:30 PM
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On 05/17/22, 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 met with Licensee Jose Pira Jr. LPA toured facility with Licensee. All clients present during tour.

Upon entry facility staffs was observed with facial mask. 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. LPA observed small amount of PPE supplies in facility. 30 days PPE supplies storage in a central location.

LPA observed fire extinguisher served date: 05/28/21. Food supply was checked and appeared to be an adequate supply. LPA checked clients’ locked medications.

All clients’ room toured and observed to be adequately furnished and lit. LPA observed 4 bedrooms that are single occupant. All bathrooms observed trash bin with lid. LPA observed hand washing posting by all sinks. Cleaning supplies were stored and locked in cabinet in the garage and laundry room.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: 05/23/22. The following updated forms were requested: Lic 400, Lic 402. and Lic 808. LPA received copy of current Administrator certificate, updated facility sketch, Lic 308, Lic 500, Lic 503, Lic 610D, Lic 9020, during facility inspection. Licensee was provided a copy of this report.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2022
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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