<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208988
Report Date: 06/20/2022
Date Signed: 06/20/2022 01:21:45 PM

Document Has Been Signed on 06/20/2022 01:21 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 2FACILITY NUMBER:
547208988
ADMINISTRATOR:BOYD, ELYSIAFACILITY TYPE:
735
ADDRESS:675 NORTH JAYE STREETTELEPHONE:
(559) 350-0141
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY: 6CENSUS: 6DATE:
06/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:42 AM
MET WITH:Elysia BoydTIME COMPLETED:
01:35 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 6/20/22, Licensing Program Analyst (LPA) M. Medina was met by Licensee 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 at facility entrance/exit point, all staff and visitors enter through activity room doors. Elysia Boyd also serves as facility Administrator, Certificate #6051876735, expires 4/17/2023.

Facility appeared clean with no obstruction or fire clearances issues. Social distancing is maintained in the common area and dining areas. Bathrooms have trash cans with lid. Hand washing posters were observed by the bathroom sink. Resident bedrooms toured, there are two shared bedrooms and two private bedrooms, bedrooms that are shared have a minimum of 6 feet between beds.

Fire extinguisher present and has a service date of 12/15/2021. Facility is equipped with pull station and strobe lights.

LPA checked residents’ medications and observed a 30-day supply. LPA observed a 2-day of perishable and a 7-day of non-perishable food available. Cleaning and PPE supplies were locked and secured under kitchen sink. Mitigation plan submitted to Department on 04/27/2021.

LPA received copies of Administrator Certificate and First Aid card during visit. The following documents to be submitted to Fresno CCL no later than 7/01/22: LIC 500, LIC 610, and LIC 9020

No deficiencies were observed. Exit interview was conducted. A copy of this report was given to 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)
Page: 1 of 1