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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209478
Report Date: 08/13/2024
Date Signed: 08/13/2024 10:05:59 AM

Document Has Been Signed on 08/13/2024 10:05 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:VALLEY CARE HOMEFACILITY NUMBER:
547209478
ADMINISTRATOR/
DIRECTOR:
NGUYEN, GINA GIAU NFACILITY TYPE:
735
ADDRESS:331 E RIVERWAY AVETELEPHONE:
(510) 469-3400
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY: 6CENSUS: 0DATE:
08/13/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:05 AM
MET WITH:Administrator, Gina NguyenTIME VISIT/
INSPECTION COMPLETED:
10:15 AM
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On 08/13/2024, Licensing Program Analyst (LPA) Walton arrived for an announced pre-licensing inspection. LPA introduced self, stated the purpose of the visit and was granted entry to the facility. LPA met with Administrator, Gina Nguyen.

The facility has 4 bedrooms and 3 bathrooms. The facility was observed to be at a comfortable temperature, 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. Fire extinguisher was observed with a service date of: 5/01/2024. Smoke detectors and carbon monoxide detector were tested and observed to be operational. Facility has a sprinkler system. The First Aid Kit was observed to have the required supplies. There is a locked cabinet in the staff office for medications and knives/sharp objects will be kept in a drawer by the stove in the kitchen . A separate locked cabinet in the laundry area will be for cleaning supplies, chemicals, and hazardous materials.

The tour started in the resident's bedrooms. Residents' bedrooms were observed to be adequately furnished with bed, drawer space, and adequate lightning. Mattresses and box springs were in good condition. A supply of linens was observed. Bathrooms were properly equipped and trash cans were observed with a tight-fitting lid. Hot water measured at 117.1 degrees F in the bathrooms. There are no bodies of water on the facility. There is a covered patio area outside the facility. A self-latching gate was also observed. Required postings were observed.

Component III was conducted during today’s pre-licensing visit.

I have found that the applicant has met all pre-licensing requirements. LPA will submit documentation to CAB in Sacramento for final review prior to license being issued.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2024
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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