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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209145
Report Date: 06/08/2022
Date Signed: 06/08/2022 01:32:20 PM

Document Has Been Signed on 06/08/2022 01:32 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 #4FACILITY NUMBER:
547209145
ADMINISTRATOR:RICO, DIANA O.FACILITY TYPE:
735
ADDRESS:829 S. COTTAGE STTELEPHONE:
(559) 791-1325
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY: 6CENSUS: 5DATE:
06/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:04 AM
MET WITH:Diana RicoTIME COMPLETED:
12:59 PM
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On /206/0822, Licensing Program Analyst (LPA) M. Medina conducted an Annual Required Infection Control Inspection. LPA Medina met by Licensee, Diana Rico and stated the purpose of the facility visit. COVID-19 guidelines are in place. Visitor log-in/temperature check was observed upon entry. Facility has one entrance/exit point. Diana Rico, Administrator Certificate #6007404735, expires 8/15/2023.

Tour of the facility conducted. Facility appeared cleaned with no obstruction or fire clearance issues. Hand sanitizer was readily available to residents and visitor. Resident bedrooms toured, resident bedrooms have a minimum of 6 feet between beds.

LPA checked residents’ medications and observed a 30-day supply, locked, secured and available. LPA observed a 2-day supply of perishable and a 7-day supply of non-perishable food available. Cleaning and PPE supplies were checked. Resident’s file have updated emergency information. LPA observed fire detectors and carbon monoxide detectors to be operational during today's inspection.

Licensee to submit updated LIC 500, LIC 610, LIC 9020, First Aid Card to Fresno CCL office no later than 6/17/22. LPA Medina received copy of Infection Control Plan during facility inspection.

Outside of facility toured. No hazards observed.

No deficiencies were observed. Exit interview was conducted. Facility report signed on site. Administrator was informed that as a COVID-19 precautionary measure, this report will be emailed.

No deficiencies issued during inspection.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 06/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/08/2022
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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