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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208880
Report Date: 07/16/2024
Date Signed: 07/16/2024 01:53:17 PM

Document Has Been Signed on 07/16/2024 01:53 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: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:
07/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:17 AM
MET WITH:Administrator, Mariana Alba Viayra and District Manager, Jose MarquezTIME VISIT/
INSPECTION COMPLETED:
02:03 PM
NARRATIVE
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On 07/16/2024, Licensing Program Analyst (LPA) Walton and Leffall arrived unannounced to conduct an annual inspection. LPAs introduced themselves, stated the purpose of the visit and requested to meet with the Administrator. LPAs were granted entry to the facility and met with Administrator, Mariana Alba Viayra and District Manager, Jose Marquez.

LPAs reviewed client records and personnel records. Personnel records were found to be current and complete. Client files were complete and current. Review of P&I records revealed a discrepancy in the account balance for S3. Interviews revealed that S3 should have a higher amount of cash funds in the facility compared to the balance on the facility records.

LPAs conducted a tour of the facility. During the inspection the facility appeared clean. Common areas were furnished and had adequate seating and lighting available. Resident bedrooms had required furnishings and adequate lighting. LPAs observed a strong urine odor and soiled bedding in bedroom 2. Residents bathrooms appeared clean, water temperature measured at 108.2 degrees F in bathroom 1 and 109 degrees F in bathroom 2. Facility kitchen appeared to be clean and safe for food preparation. LPAs observed an adequate food supply.

Exterior tour conducted, all exits open and free of obstructions on today’s visit. Fire extinguishers are current with a service date of 11/16/2023. Smoke detectors and carbon monoxide detector observed to operational. Last fire drill conducted on 06/10/2024. Cleaning supplies observed to be locked in a cabinet in the activities room. Medications observed to be locked and administered as prescribed.

Deficiencies are being cited in accordance to California Code of Regulations, Title 22, Division 6 on the attached 809D.

Exit interview conducted and a plan of correction was reviewed and developed. A copy of this report and appeal rights were discussed and provided to Administrator, Mariana Alba Viayra, whose signature on this form confirms receipt of this document.

LPA is requesting the following documents be submitted to the Fresno CCL office by 07/30/2024: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Emergency and Disaster Plan (LIC610D), Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020) Surety Bond.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 07/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/16/2024
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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Document Has Been Signed on 07/16/2024 01:53 PM - It Cannot Be Edited


Created By: Alexandria Walton On 07/16/2024 at 01:10 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: PEOPLE'S CARE MARLIN
FACILITY NUMBER: 547208880

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80026(h)
80026 Safeguards for Cash Resources, Personal Property, and Valuables of Residents
(h) Each licensee shall maintain accurate records of accounts of cash resources, personal property, and valuables entrusted to his/her care, including, but not limited to the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above when S3 should have higher amount of cash funds than indicated on the facility ledger which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/16/2024
Plan of Correction
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Licensee agrees to locate the missing funds and provide a written statement to the Fresno CCL office detailing how the facility will ensure that S3 has an accurate account balance on record.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Melinda Hoffmann
LICENSING EVALUATOR NAME:Alexandria Walton
LICENSING EVALUATOR SIGNATURE:
DATE: 07/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/16/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/16/2024 01:53 PM - It Cannot Be Edited


Created By: Alexandria Walton On 07/16/2024 at 01:20 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: PEOPLE'S CARE MARLIN
FACILITY NUMBER: 547208880

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Deficiency Dismissed
Type B
Section Cited
CCR
80087(a)
Building and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above when a strong urine odor was present and soiled bedding was observed in bedroom 2, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/26/2024
Plan of Correction
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Licensee agrees to submit a written statement detailing the steps the facility will take to ensure the requirements for the above section are met to the Fresno CCL office by the POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Melinda Hoffmann
LICENSING EVALUATOR NAME:Alexandria Walton
LICENSING EVALUATOR SIGNATURE:
DATE: 07/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/16/2024


LIC809 (FAS) - (06/04)
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