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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209302
Report Date: 05/23/2024
Date Signed: 05/24/2024 08:36:53 AM

Document Has Been Signed on 05/24/2024 08:36 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:VELA SUITESFACILITY NUMBER:
107209302
ADMINISTRATOR/
DIRECTOR:		GRICE, SASHEILAFACILITY TYPE:
740
ADDRESS:6572 NORTH MARIPOSA ST.TELEPHONE:
(559) 438-0980
CITY:FRESNOSTATE: CAZIP CODE:
93710
CAPACITY: 6CENSUS: 5DATE:
05/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:05 PM
MET WITH:Sasheila Grice, LicenseeTIME VISIT/
INSPECTION COMPLETED:
05:05 PM
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Licensing Program Analyst L. Padgett (LPA), conducted an unannounced annual visit to the facility. LPA was granted entry by staff, Angelica Escobar. Administrator/Licensee Sasheila Grice was called and arrived later. LPA stated the purpose of the visit and was accompanied by AD while conducting the inspection of the facility. At the time of the visit, LPA observed 5 residents are in the facility.

LPA observed the living room has electric fireplace. Television was observed to be in a secure place. LPA observed 6 recliners. The living room has a sliding glass window that was clean and not obstructed, a table lamp and extra chair. The furniture was clean and in good condition.

LPA observed that the kitchen was well maintained, with working lights and well maintained appliances. The knives were kept in a locked drawer not easily accessible. The kitchen counters and sink are free from debris. In locked cabinet under the sink are extra hand soaps and dish soap. LPA observed a trash bin with the lid. LPA observed that refrigerator is well maintained and clean and set to coldest setting on both. LPA observed a 2 day perishable food supply. The kitchen pantry was clean, organized, and had 7 days of non-perishable food. No expired food was observed.

LPA observed the dining room is well lit. Dining table has seating for 4. A fire extinguisher is mounted on the wall and inspected on 1/18/2024 with the correct pressure gauge as indicated on the meter.

LPA observed that the garage is well maintained, free from obstructions and debris The garage is kept locked. The garage has storage cabinets with extra non-perishable food and incontinence supplies (diapers, chucks, gloves). The storage cabinets. There are two refrigerators with juices and other foods and a deep freezer stocked with extra meats and frozen foods.

LPA observed laundry appliances to be working. Cleaning chemicals are kept in locked closet in the laundry room.

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Lissett Padgett
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: VELA SUITES
FACILITY NUMBER: 107209302
VISIT DATE: 05/23/2024
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In the hallway that leads to the bedrooms, LPA observed smoke detector and carbon monoxide detector installed in hall and in the bedrooms. The smoke alarm and carbon monoxide detectors were tested by the AD and are functioning.

LPA inspected the two hallway bathrooms and observed that the bathroom is well maintained, well lit, has toilet paper, hand soap, a trash bin with lid. Water temperature measured at 108.1 and 108.0 degrees F. The bathrooms was observed to have non-skid floor mat, grab bars, grip bar next to the toilet and shower bench. The toilets were flushed and are functioning.

LPA observed the linen closet next to the have clean towels and linens.

LPA inspected the 6 resident bedrooms with AD. LPA observed all bedrooms are single occupant. Bedrooms are well lit, a dresser, reading lamp, night stand the hospital beds are in good condition, the linens are in good condition. The bedrooms have a closet.

LPA inspected the backyard. LPA, observed that the backyard is well maintained, trees and grass in good condition. LPA observed the patio furniture under patio umbrella is clean and ready for use. The exterior walkways are free from obstructions and debris.

LPA observed medications are stored in locked hall closet. LPA observed medications are stored in bins labeled with each residents name. First aid kit was inspected and found to contain the required items.

LPA reviewed residents and staff records with AD and found that all documents are in order and up to date.

LPA is requesting the following documents be submitted to the Fresno CCL office by 5/31/2024 Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance, Emergency and Disaster Plan (LIC 610D) Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020A), Surety Bond.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Lissett Padgett
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024
LIC809 (FAS) - (06/04)
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