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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209163
Report Date: 06/08/2022
Date Signed: 06/08/2022 10:45:17 AM

Document Has Been Signed on 06/08/2022 10:45 AM - 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:FARMER RESIDENTIAL HOMEFACILITY NUMBER:
547209163
ADMINISTRATOR:FARMER, RHONDIFACILITY TYPE:
735
ADDRESS:1061 S ROYAL OAKTELEPHONE:
(559) 920-2975
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY: 4CENSUS: 4DATE:
06/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:53 AM
MET WITH:Rhondi FarmerTIME COMPLETED:
10:54 AM
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On 6/08/22, LPA Medina conducted an unannounced Annual Required Infection Control Inspection. LPA met by Licensee/Administrator, Rhondi Farmer to conduct facility tour and inspection. All 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 front 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. Resident bedrooms toured, all residents have private bedrooms. Smoke detectors/carbon monoxide detectors observed to be operational during inspection. Water temperature measured at 116 degrees F.

Medication observed to be locked and secured in medication cart, a 30-day supply of medication is available. LPA observed a 2-day supply of perishable and a 7-day supply of non-perishable food available for residents. Facility staff was observed with mask on.

LPA received updated copies CPR/First, LIC 500, LIC 610, and LIC 9020, and Infection Control Plan during inspection.

No deficiencies were observed. Exit interview was conducted. A copy of report was given to Administrator for facility records.
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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