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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208237
Report Date: 06/08/2022
Date Signed: 06/08/2022 03:36:03 PM

Document Has Been Signed on 06/08/2022 03:36 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:RICO RESIDENTIAL FACILITY #2FACILITY NUMBER:
547208237
ADMINISTRATOR:RICO, DIANA OFACILITY TYPE:
735
ADDRESS:1187 N HOWLAND STTELEPHONE:
(559) 793-4110
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY: 6CENSUS: 6DATE:
06/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:18 PM
MET WITH:Diana Rico TIME COMPLETED:
03:34 PM
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On 6/08/22, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required inspection on this date. LPA met with Licensee, Diana Rico and stated purpose of visit. COVID-19 guidelines and precautions are in placed and observed upon entry. All staff and visitors enter through one entry point. A temperature check and sign in book observed at entry point.

Facility observed to be clean and odor free. Residents arrived home from day program during facility inspection. Staff observed to be wearing face masks. Facility has a 30-day supply of PPE on site and available. Hand sanitizer readily available for staff and residents. Soap, paper towels available at all sinks. Hand washing signs posted in the bathrooms.

Resident medication observed to be stored and secured, and a 30-day supply is available for residents. A 2-day supply of perishable and a 7-day supply of non-perishable of food available. All fire exits open freely and have to obstructions.

Fire extinguisher present with a service date of 11/16/2021. Carbon monoxide and smoke detectors present and observed operational.

Licensee to submit updated LIC 500, LIC 610, LIC 9020, First Aid Card to Fresno CCL office no later than 6/17/22. LPA Medina received copy of Infection Control Plan during facility inspection.

No deficiencies were observed. Exit interview was conducted. Administrator provided copy of this report for facility file.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 06/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/08/2022
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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