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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208819
Report Date: 11/15/2022
Date Signed: 11/15/2022 02:40:34 PM

Document Has Been Signed on 11/15/2022 02:40 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:PATRIOT IN THE WESTFACILITY NUMBER:
547208819
ADMINISTRATOR:KYLA SEVERNSFACILITY TYPE:
735
ADDRESS:3702 N SALLEE STREETTELEPHONE:
(661) 340-4457
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY: 4CENSUS: 4DATE:
11/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:36 PM
MET WITH:Ismael Talavara, AdministratorTIME COMPLETED:
03:00 PM
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On 11/15/22, 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 Felicity Stutsman, Project Liaison Assurance Development. Ismael Talavara, Administrator was called and arrived shortly. LPA conducted a facility tour with Administrator. There are currently two clients present during tour.

Upon entry facility staffs was observed with facial mask. Visitor log-in/temperature check was observed. 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 COVID-19 signs and cough etiquette postings in facility. LPA observed fire extinguisher served date: 01/13/22.

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 no lid. LPA observed hand washing posting by all sinks. Cleaning supplies were stored and locked in hallway closet and garage. LPA checked clients’ locked medications and observed a small amount of 30-day PPE supplies. 30 days PPE supplies storage in a central location. Food supply was checked and appeared to be an adequate supply.

The exterior tour was conducted. Side gate was self-closing and self-latching. 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: 11/21/22. The following updated forms were requested: Lic 308, Lic 400, Lic 402, Lic 500, Lic 610D, Lic 9020, Lic 9282, and current Administrator Certificate. A copy of this report was provided to the Administrator.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2022
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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