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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209340
Report Date: 01/16/2025
Date Signed: 01/16/2025 04:58:52 PM

Document Has Been Signed on 01/16/2025 04:58 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:DOROTHY WILSON HOMEFACILITY NUMBER:
547209340
ADMINISTRATOR/
DIRECTOR:		FROSHOUR, TISHIE MARIEFACILITY TYPE:
735
ADDRESS:3611 W MILLCREEK DRTELEPHONE:
(559) 733-9013
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY: 4CENSUS: 2DATE:
01/16/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:05 PM
MET WITH:Tishie Marie FroshourTIME VISIT/
INSPECTION COMPLETED:
03:51 PM
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On 1/16/2025, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Inspection visit. LPA Medina arrived, introduced self, and allowed entrance by Licensee.

Currently, there are two residents residing in facility. Both residents returned from day program during facility inspection. Residents attend day program Monday through Friday, 7:30 AM to 1:30 PM. Facility tour began in resident bedrooms. Bedrooms observed to have all required furnishings. Residents bathrooms observed to be clean and in good repair. Shower/tub has a non-skid surface and grab bars. Hot water in hallway bathroom measured at 120 degrees F. Dining room and living room have adequate seating and lighting for all residents in care. Tour of kitchen conducted. LPA observed facility to have a 2-day supply of perishable food and a 7-day supply of non-perishable food available for residents. Medications observed to be locked in cabinet in the office and inaccessible to residents. Medications observed to have original labels and be administered as prescribed.

Smoke Alarms and carbon monoxide detectors observed to be operational at time of visit. Fire extinguisher has a service date 7/30/2024. Last fire drill conducted on 1/1/2025 and last disaster drill conducted on 11/01/2024 according to facility records. First Aid kit and first aid manual present and observed to have all required items. LPA reviewed facility disaster binder during inspection.

Outside areas toured. All exits open observed to be free of obstruction. Pool is locked and secured and inaccessible to residents. No hazards observed.

Staff and resident files reviews.

No deficiencies cited during visit.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2025
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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