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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208764
Report Date: 08/25/2022
Date Signed: 08/25/2022 10:16:21 AM

Document Has Been Signed on 08/25/2022 10:16 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:WILLIAM'S RESIDENTIAL CARE FOR THE ELDERLY LLCFACILITY NUMBER:
107208764
ADMINISTRATOR:RUNDERSON, MARTHA MFACILITY TYPE:
740
ADDRESS:2909 EAST GRIFFITH WAYTELEPHONE:
(559) 226-1082
CITY:FRESNOSTATE: CAZIP CODE:
93726
CAPACITY: 3CENSUS: 3DATE:
08/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:02 AM
MET WITH:Martha Runderson TIME COMPLETED:
10:25 AM
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On 8/25/22, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required Inspection. LPA introduced self and allowed entrance by Direct Care Staff, Administrator contacted by telephone and arrived a short time later to conduct inspection visit.

Three (3) residents present during start of facility inspection sitting outside with staff upon arrival.

LPA Medina observed a visitor/temperature log, thermometer, masks, and disinfection station at the front entrance. Facility has one entry and exit point. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common areas. Hand washing and other various COVID-19 signs were observed in the common areas.

Facility toured, all common areas have sufficient seating and lighting for all residents in care. All resident bedrooms are private. LPA observed a 2-day supply of perishable food and 7-day supply of non-perishable food. Cleaning supplies and medication were observed behind a locked door. Personal Protective Equipment (PPE) is on site and available.

Outside of facility toured. All exits open free of obstruction.

No deficiencies observed.

Exit interview conducted and a copy of report provided for facility records.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 08/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2022
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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