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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208953
Report Date: 06/20/2022
Date Signed: 06/20/2022 03:57:14 PM

Document Has Been Signed on 06/20/2022 03:57 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:WIGGINS HOME 1FACILITY NUMBER:
547208953
ADMINISTRATOR:BOYD, ELYSIAFACILITY TYPE:
735
ADDRESS:1562 WEST CLARE AVENUETELEPHONE:
(559) 350-0141
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY: 6CENSUS: 4DATE:
06/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:53 PM
MET WITH:Elysia BoydTIME COMPLETED:
03:39 PM
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On 6/20/2022, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required Inspection. LPA met with Licensee/Administrator, Elysia Boyd 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, all staff and visitors enter through back patio door.

Facility appeared clean with no obstruction or fire clearance issues. Hand sanitizer was readily available to resident and visitors. Social distancing is maintained in the common and dining areas. Bathrooms have trash cans with lid. Hand washing posters were observed by the bathroom sink. Resident bedrooms toured, all resident rooms are private.

Fire extinguisher present and has a service date of 1/27/2022. Carbon monoxide detector observed operational during inspection. Facility is equipped with pull station an fire sprinklers.

Food supply was observed to be adequate for residents in care. Cleaning and PPE supplies were checked.

LPA received a copy of Administrator certificate and First Aid card during inspection. Licensee to submit LIC 500, LIC 610 and LIC 9020 to Fresno CCL office no later than 7/1/2022.

No deficiencies observed during inspection. Exit interview conducted. LPA left copy of facility report with licensee.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2022
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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