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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209273
Report Date: 01/13/2023
Date Signed: 01/13/2023 11:16:23 AM

Document Has Been Signed on 01/13/2023 11:16 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:KNOTTS LANDING CARE HOMEFACILITY NUMBER:
547209273
ADMINISTRATOR:KNOTT, SHEENAFACILITY TYPE:
735
ADDRESS:208 JENNIFER DR.TELEPHONE:
(208) 713-3561
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY: 4CENSUS: 0DATE:
01/13/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Sheena KnottTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) L. Xiong conducted an announced Pre-licensing Inspection. I met with Administrator Sheena Knott and informed them the purpose of the visit.

The facility was, clean, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. Common areas were properly furnished and well-lit throughout. Smoke detectors and carbon monoxide detector were and observed to be operational.

There was a locked cabinet in the kitchen for medications and knives/sharp objects. Cleaning supplies, chemicals, and hazardous materials were stored in the laundry room in a locked cabinet. Resident and personnel files will be stored in a locked facility office.

The residents' bedrooms were observed to be furnished with bed, dresser, night stand, lamp, chair and adequate lightning. Mattresses were in good condition. A sufficient supply of linens and towels was observed.

Bathrooms equipped in the tubs/showers. Hot water was tested with a thermometer and reflected a temperature of 117 degrees Fahrenheit.

A self-latching gate was also observed.

Component III was conducted and completed. Exit interview was conducted. Pending licensure by Centralized Application Bureau (CAB)
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Les Xiong
LICENSING EVALUATOR SIGNATURE: DATE: 01/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/13/2023
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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