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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157203358
Report Date: 10/15/2024
Date Signed: 10/16/2024 09:08:53 AM

Document Has Been Signed on 10/16/2024 09:08 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:POSITIVE DIRECTIONS #9FACILITY NUMBER:
157203358
ADMINISTRATOR/
DIRECTOR:		MARIA ORTIZFACILITY TYPE:
740
ADDRESS:329 EL CAMINO DRIVETELEPHONE:
(661) 721-3525
CITY:DELANOSTATE: CAZIP CODE:
93215
CAPACITY: 4CENSUS: 3DATE:
10/15/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Maria "Alicia" Ortiz, Administrator TIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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On 10/14/24, Licensing Program Analyst (LPA) L. Salazar arrived to the facility unannounced to conduct a Health and Safety inspection based on a death report received 10/14/24. LPA met with Administrator, stated the purpose and was allowed entry into the facility.

LPA toured the facility and observed 3 residents in care at the time of visit, 2 staff and Administrator were present. LPA observed a 7-day supply of non perishables and 2 day supply of perishables. Facility inside temperature measured at 74 degrees.

LPA requested Resident R1's file and obtained the following information: Admission Agreement, vendor referral form, Hospital discharge papers, staff schedule for October, Personnel report LIC 500, and facility progress notes. Administrator was unable to provide pre-admission appraisal (LIC603a), physician's report (LIC602a) or needs and service appraisal (LIC625) or reassessment/functional capabilities assessment (LIC 9172).

Exit interview conducted. LPA will review documentation received and return at a later date to issue deficiencies. No deficiencies cited on today's visit.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2024
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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