<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547206804
Report Date: 10/07/2021
Date Signed: 10/07/2021 04:25:42 PM

Document Has Been Signed on 10/07/2021 04:25 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:ORDUNO HOME 3FACILITY NUMBER:
547206804
ADMINISTRATOR:ORDUNO, LAURAFACILITY TYPE:
735
ADDRESS:515 N PLANO STTELEPHONE:
(559) 784-4980
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY: 6CENSUS: 3DATE:
10/07/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:01 PM
MET WITH:Carol OrdunoTIME COMPLETED:
04:25 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 10/07/21, Licensing Program Analyst (LPA) M. Medina arrived unannounced to conduct an Annual Required Infection Control. LPA met with Licensee, Carol Orduno, introduced self, stated the purpose of the visit. Upon entering the facility, LPA observed visitor log/temperature check. Facility has one central entrance and exit

Facility tour conducted with Licensee. Facility appeared cleaned 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. All residents have private bedrooms.

LPA observed medication to be locked, residents observed a 30-day supply. LPA observed a 2-day supply of perishable and a 7-day supply of non-perishable food available. Cleaning and PPE supplies were checked. Facility staff was observed with mask on.

Licensee provided LPA Medina with copies of Administrator Certificate, First Aid, LIC 500, LIC 610 and LIC 9020.

LPA observed the required infection control practices to be in compliance. No deficiencies were observed. Exit interview was conducted and Licensee 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: 10/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/07/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1