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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208243
Report Date: 08/05/2022
Date Signed: 08/05/2022 10:29:54 AM

Document Has Been Signed on 08/05/2022 10:29 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:ENCLAVE AT THE FOOTHILLSFACILITY NUMBER:
547208243
ADMINISTRATOR:PEREZ, KRISTINAFACILITY TYPE:
735
ADDRESS:10650 ROAD 256TELEPHONE:
(559) 527-5090
CITY:TERRA BELLASTATE: CAZIP CODE:
93270
CAPACITY: 20CENSUS: 18DATE:
08/05/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Assistant Administrator Javier Hernandez TIME COMPLETED:
10:40 AM
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On 8/5/22, 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 Marissa Munoz medication tech. Assistant Administrator arrived later during tour. There are currently 18 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 not observed 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 fire extinguisher served date: 08/4/22. LPA checked clients’ locked medications.

All clients’ room toured and observed to be adequately furnished and lit. LPA observed six shared residents’ bed to be at least 6 feet apart and seven single occupant room.

All bathrooms observed trash bin with lid. LPA observed hand washing posting observed by all sinks. Food supply was checked and appeared to be an adequate supply. LPA observed 30 days PPE supplies.

The exterior tour was conducted. Outside free of obstruction. Staff records were reviewed for good health and infection control training. A sample of 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: 8/11/22. The following updated forms were requested: Lic 308, Lic 309, Lic 400, Lic 402, Lic 500, Lic 9020, Lic 610D and current Administrator certificate. A copy of this report was provided to Assistant Administrator.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 08/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/05/2022
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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