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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 547209134
Report Date: 04/29/2022
Date Signed: 04/29/2022 11:52:59 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/05/2022 and conducted by Evaluator Mai Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20220405105308
FACILITY NAME:DEENA'S CARE HOMEFACILITY NUMBER:
547209134
ADMINISTRATOR:PATCH, DEENAFACILITY TYPE:
735
ADDRESS:3537 W. CUTLER AVE.TELEPHONE:
(559) 679-4609
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY:6CENSUS: 4DATE:
04/29/2022
UNANNOUNCEDTIME BEGAN:
10:59 AM
MET WITH:Deena Patch, LicenseeTIME COMPLETED:
12:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Kitty litter box is kept in kitchen making kitchen unsanitary
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 04/29/22, Licensing Program Analyst (LPA) M. Yang arrived unannounced to deliver findings on the above allegation. LPA introduced self, stated the purpose of the visit, and met with Licensee Deena Patch.

During the course of the investigation, LPA reviewed photo submitted, and conducted interviews. Based on the photos provided, cat litter box was under kitchen counter. LPA conducted interview with staff and it was confirmed cat litter box was located in kitchen area unsanitary since January 2022.

Based on the review of photo and interview conducted the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 are being cited on the attached LIC 9099D.

An exit interview was conducted. A copy of this report and Appeal rights were provided to Administrator.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 24-AS-20220405105308
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: DEENA'S CARE HOME
FACILITY NUMBER: 547209134
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/29/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/29/2022
Section Cited
CCR
80076(a)(15)
1
2
3
4
5
6
7
80076 Food Services (a) In facilities providing meals to clients, the following shall apply: (15) Pesticides and other similar toxic substances shall not be stored in food storerooms, kitchen areas, food preparation areas, or areas where kitchen equipment or utensils are stored.

This requirement is not met as evidenced by:

1
2
3
4
5
6
7
Cat litter removed from under kitchen counter. POC cleared during visit.
8
9
10
11
12
13
14
Based on photo reviewed and interview, cat litter was located under kitchen counter, which poses/posed a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4