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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208942
Report Date: 03/28/2022
Date Signed: 03/28/2022 12:26:07 PM

Document Has Been Signed on 03/28/2022 12:26 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 #3FACILITY NUMBER:
547208942
ADMINISTRATOR:RICO, DIANA OFACILITY TYPE:
735
ADDRESS:2001 CHRIS CTTELEPHONE:
(559) 788-0833
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY: 4CENSUS: 3DATE:
03/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Diana Rico TIME COMPLETED:
11:51 AM
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On 3/28/22, Licensing Program Analyst (LPA) M. Medina conducted an Annual Required Infection Control Inspection. LPA was met by Licensee, Diana Rico and stated the purpose of the visit. A tour of the facility was conducted. COVID-19 guidelines are in place. Visitor log-in/temperature check was observed upon entry. Facility has one entrance/exit point.

Facility appeared cleaned with no obstruction or fire clearance issues. Facility is equipped with pull station and sprinkler system. Fire extinguisher present with a service date of 1/28/22. Carbon monoxide detector present and observed operational. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common and dining areas. Bathrooms have trash cans with lid. Bedrooms were checked and beds are six feet apart.

LPAs checked residents’ medications and observed a 30-day supply. Food supply was checked and observed to be adequate for residents in care. Facility has adequate supply of PPE supplies available. Staff records were reviewed for good health and infection control training. Facility staff was observed with mask on.

No deficiencies were observed. Exit interview was conducted. Licensee was informed that as a COVID-19 precautionary measure, this report will be emailed. Facility inspection report was signed on site.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 03/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2022
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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