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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209219
Report Date: 08/18/2022
Date Signed: 08/18/2022 12:48:17 PM


Document Has Been Signed on 08/18/2022 12:48 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:KAWEAH HEALTH RUTH WOOD OPEN ARMS HOUSEFACILITY NUMBER:
547209219
ADMINISTRATOR:SALAZAR, DEBORAHFACILITY TYPE:
740
ADDRESS:3234 W. IRIS AVE.TELEPHONE:
(559) 733-0642
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY:6CENSUS: 3DATE:
08/18/2022
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
08:40 PM
MET WITH:Administrators, Deborah “Debbie” Salazar, Director Tiffany Bullock, staff Jacklyn BecerraTIME COMPLETED:
10:45 PM
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Licensing Program Analyst (LPA) M. Yang arrived unannounced for a Post Licensing Inspection. LPA met staff Jacklyn Becerra. LPA introduced self, stated the purpose of the visit, and requested to meet with the Administrator. Upon entry staffs was observed wearing facial covering. Administrators, Deborah “Debbie” Salazar was called and arrived shortly with Director Tiffany Bullock. LPA toured facility with staff, Administrator, and Director.

All three residents present during tour. LPA observed cough etiquette and social distancing posting. Facility was observed at a comfortable temperature, clean, and no passageway obstructions or fire hazards inside. Facility was free from ground obstructions and odor free. Common areas were observed to have adequate seating and lighting available.

Kitchen was toured and observed. Knives were observed kept locked and secure in the kitchen drawer. LPA observed a 2-day supply of perishable and 7-day supply of non-perishable food. A fire extinguisher was observed and had a service date of 06/02/2022. Cleaning supplies and chemicals observed to be locked in a closet in the office. LPA observed an extra supply of bed linens and personal hygiene products. LPA observed hand washing signs by bathroom sinks. LPA observed three single occupant bedrooms and three vacant bedrooms. Bedrooms were observed furnished and lit. Medications observed locked in medication drawers.

Outside of facility toured. Exits were open and free of obstructions. LPA observed side gate to be self-latching. LPA observed a 30-day PPE supplies. All resident’s file reviewed to have updated emergency contact information and Admission agreements on file. Staff’s file was also reviewed with current 1st Aid/ CPR.

No deficiencies issued during this inspection.

Exit interview was conducted. A copy of this report will be provided via email and an electronic read receipt confirms receiving this email. Signed report on file.

SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:
DATE: 08/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/18/2022
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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