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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208880
Report Date: 04/30/2024
Date Signed: 04/30/2024 10:33:59 AM

Document Has Been Signed on 04/30/2024 10:33 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:PEOPLE'S CARE MARLINFACILITY NUMBER:
547208880
ADMINISTRATOR/
DIRECTOR:		VIAYRA,MARIANAFACILITY TYPE:
735
ADDRESS:12744 MARLIN AVETELEPHONE:
(559) 372-8827
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY: 4CENSUS: 4DATE:
04/30/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:05 AM
MET WITH:Pending Administrator Mariana ViayraTIME VISIT/
INSPECTION COMPLETED:
10:32 AM
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Licensing Program Analyst (LPA) Darius Williams conducted an unannounced follow up Case Management visit from, 4/22/2024.

LPA conducted interviews and record reviews.

All staff involved in the restraint hold a current CPI certificate.

The facility conducted a debriefing on 4/15/2024 and documented the incident.

According to Resident 1's Individual Program Plan, there is a goal to reduce Fabricating Stories, which is defined as any instance of making verbal statements about events that are factually inaccurate(i.e. saying R1 has completed a task that R1 has not completed, saying a person did something they did not, etc).

LPA asked Resident 1 about the incident and R1 reported not remembering. LPA asked the question in other ways and received similar answers.

No deficiencies were cited.

An exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Darius Williams
LICENSING EVALUATOR SIGNATURE: DATE: 04/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/30/2024
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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