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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208764
Report Date: 07/29/2024
Date Signed: 07/29/2024 06:25:44 PM

Document Has Been Signed on 07/29/2024 06:25 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:WILLIAM'S RESIDENTIAL CARE FOR THE ELDERLY LLCFACILITY NUMBER:
107208764
ADMINISTRATOR/
DIRECTOR:		RUNDERSON, MARTHA MFACILITY TYPE:
740
ADDRESS:2909 EAST GRIFFITH WAYTELEPHONE:
(559) 226-1082
CITY:FRESNOSTATE: CAZIP CODE:
93726
CAPACITY: 3CENSUS: 3DATE:
07/29/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH: Direct Support Professional (DSP) Kimberly Evans; Licensed Vocation Nurse (LVN) Denise HolleyTIME VISIT/
INSPECTION COMPLETED:
06:45 PM
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An unannounced Annual visit was conducted on the date & times indicated above by Licensing Program Analyst (LPA) K. Mcclurg. LPA met with Direct Support Professional (DSP) Kimberly Evans. LPA introduced self, presented business card, stated purpose of visit & was allowed to proceed with visit. LPA was later joined by Licensed Vocation Nurse (LVN) Denise Holley. Administrator Martha Runderson not available @ time of visit. Visit conducted w/ LVN, authorized to sign for report.

Physical plant toured. Living & dining room sufficiently furnished with adequate lighting. Kitchen toured. Knives inaccessible. Sufficient supply of dining wear & utensils. Appliances appeared to be clean & @ appropriate temperatures. Hallways clear & free of obstructions. Closets off of hall way observed to contain sufficient supply of clean linens. Laundry area observed to have detergents in locked cabinet over appliances.

Resident rooms & bathrooms toured. Resident rooms sufficiently furnished with adequate lighting. Blinds in good condition. Screens on all windows & sliding glass doors. Three bedrooms have sliding glass doors & 1 room with direct egress access across hall. Bathrooms fixtures operational. Non-skid mats & grab bars in all toilet, & tub/shower areas. Hot water measured at 113 degrees F. Medications observed to be locked & organized.

Outside area toured. Clear passageways with no obstructions through side yards to back yard. Yards maintained w/ sufficent lawn care. Hoses coiled up & out of the way eliminating predictable tripping hazard. Operational smoke & carbon monoxide detectors. Fire extinguisher service date: 1/23/24.

Exit interview conducted with LVN. Report provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE: DATE: 07/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/29/2024
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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