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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209252
Report Date: 07/30/2024
Date Signed: 07/30/2024 03:45:35 PM

Document Has Been Signed on 07/30/2024 03:45 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:CROWE HOUSE LLC, THEFACILITY NUMBER:
547209252
ADMINISTRATOR/
DIRECTOR:		MARTINEZ, EESAENGFACILITY TYPE:
735
ADDRESS:13274 PERRY CT.TELEPHONE:
(559) 786-1819
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY: 4CENSUS: 2DATE:
07/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Administrator (Admin) Eesaeng MartinezTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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An Annual visit was conducted on the date above by Licensing Program Analyst (LPA) K. McClurg. LPA met with Administrator (Admin) Eesaeng Martinez. LPA greeted Admin, stated purpose of visit & was allowed entry. This facility has an in-ground pool.
Facility telephone number is (559) 713-6985.

Physical plant toured. Living, dining rooms sufficiently furnished with adequate lighting.
Kitchen toured. Kitchen appeared to be clean with no debris on counters. Knives locked & inaccessible to clients. 2 day perishable & 7 day non-perishable food on the premises. Appliances appeared to be clean with no unpleasant odors & maintained @ appropriate temperature. Tight fitting lids on trash can. Hallways & passageways observed to be clear & free of obstruction.

Resident bedrooms & bathrooms toured. Resident rooms sufficiently furnished with adequate lighting. Appropriate linens on client beds. Sufficient supply of linens available. Resident bathroom fixtures operational. Hot water measured in mid-hallway bath @ 135 degrees F. Hot water adjusted @ time of visit & measured @ 120 degrees F. Bathrooms appeared to be clean with no unpleasant odors. Trash cans have tight fitting lids.



Continued.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE: DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/30/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: CROWE HOUSE LLC, THE
FACILITY NUMBER: 547209252
VISIT DATE: 07/30/2024
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Continued


Home a comfortable temperature throughout.
Operational smoke & carbon monoxide detectors. Fire extinguisher service date: 4/25/24

Medication stored in locked cabinet & organized. Medication records reviewed. Client & staff records reviewed. Administrator certificate #6051208735 exp. 6/3/25. Admin holds current water safety certificated.

Garage area toured. Hazardous items including detergents, solvents, etc locked in area in garage or locked in workshop on property - including gasoline powered lawn mower, etc. Outside area toured. Yard maintained. No dried grasses or weeds in need of removal for fire purposes. In ground pool in backyard surrounded by 5 foot fencing with locking gate that was observed to be locked @ time of visit. Back area of property has separately fenced area where shop is located. Shop is kept locked except when directly in use. Shop stores gasoline powered lawn equipment & miscellaneous tools & supplies stored to keep hazardous items inaccessible to clients. No hazards observed.

Deficiency issued & cleared @ time of visit. Copy of POC letter provided @ time of visit.

Exit interview conducted. Report provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024
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Document Has Been Signed on 07/30/2024 03:45 PM - It Cannot Be Edited


Created By: Kelly J. McClurg On 07/30/2024 at 03:29 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: CROWE HOUSE LLC, THE
FACILITY NUMBER: 547209252

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/30/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/30/2024
Plan of Correction
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Hot water in mid-hall bath measured @ 135 degrees F. Hot water adjusted @ time of visit & brought into compliance measuring 120 degrees F.
DEFICIENCY CLEARED @ TIME OF VISIT
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:See Moua
LICENSING EVALUATOR NAME:Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE:
DATE: 07/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/30/2024


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