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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206776
Report Date: 02/09/2022
Date Signed: 02/09/2022 03:02:37 PM

Document Has Been Signed on 02/09/2022 03:02 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:IDEAL CARE CENTERSFACILITY NUMBER:
107206776
ADMINISTRATOR:IDONI, GREGORY AFACILITY TYPE:
740
ADDRESS:3618 W DAYTON AVETELEPHONE:
(559) 275-2488
CITY:FRESNOSTATE: CAZIP CODE:
93722
CAPACITY: 6CENSUS: 5DATE:
02/09/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Gregory IdoniTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Katie Brown conducted Case Management in conjunction with the Infection Control Annual Inspection. LPA met with Administrator Gregory Idoni.

During the Infection Control Inspection, the following was observed by the LPA:

Storage Space:


Cleaning supplies and sharps accessible to residents

Maintenance and Operation:


Light switch panels to be replaced, bathroom base board to be secured, resident bedding and mattress protector replacement & carpet cleaning

The following deficiencies were observed and noted on the attached LIC 809D. All violations that, if not corrected, will have direct and immediate risk to the health, safety or personal rights of clients in care

A copy of this report along with Appeal Rights were provided and an exit interview was conducted with Administrator Gregory Idoni.

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Katie Brown
LICENSING EVALUATOR SIGNATURE: DATE: 02/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/09/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 02/09/2022 03:02 PM - It Cannot Be Edited


Created By: Katie Brown On 02/09/2022 at 02:09 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: IDEAL CARE CENTERS
FACILITY NUMBER: 107206776

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/10/2022
Section Cited
CCR
87309(a)

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87309 Storage Space (a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement was not met as evidenced by:
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Licensee corrected the deficiency during the visit. All cleaning supplies and sharps were moved to a locked cabinet.

Licensee has agreed to place new locks in the kitchen to properly store cleaning supplies, sharps and medications. Proof of repair will be provided to CCLD by 2/23/22.
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Licensee did not encure that Disinfectants, cleaning supplies and sharps were inaccessible to clients. Cleaning supplies and sharps were not locked.

This poses an immediate health and safety risk to persons in care.
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Type B
02/23/2022
Section Cited
CCR87303(a)(1)

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87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. (1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition.
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Licensee has agreed to replace broken light switches and covers. Soiled box spring & matress will be replaced and covered with waterproof matress pad. Resident carpets will be cleaned. Weekly housekeeping checklist to be updated. Proof of correction will be provided to CCLD by 2/23/22.
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This requirement was not met as evidenced by: Licensee did not ensure that the facility was sanitary and in good repair. LPA observed broken light switch panels, unsecured baseboard in bathroom, soiled resident carpet, bed linens and matress.
***This poses a potential Health & safety risk to persons in care.
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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:Sergiy Pidgirny
LICENSING EVALUATOR NAME:Katie Brown
LICENSING EVALUATOR SIGNATURE:
DATE: 02/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/09/2022


LIC809 (FAS) - (06/04)
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