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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 277209403
Report Date: 09/10/2024
Date Signed: 09/10/2024 02:14:18 PM

Document Has Been Signed on 09/10/2024 02:14 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
FRESNO ASC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:R&A MANORFACILITY NUMBER:
277209403
ADMINISTRATOR/
DIRECTOR:		ESPIRIDION, RITCHIEFACILITY TYPE:
740
ADDRESS:1533 COUGAR DR.TELEPHONE:
(831) 869-6957
CITY:SALINASSTATE: CAZIP CODE:
93905
CAPACITY: 6CENSUS: 1DATE:
09/10/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Licensee, Ritchie EspiridionTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) S. Hurt arrived for a post licensing inspection. LPA was met by Licensee Ritchie Espiridion. The facility has one resident who was present during this inspection.

Licensee Ritchie Espiridion recently contacted LPA Hurt informing the facility has one resident.
A complete tour of the facility was done. Medications are properly stored and secured in a locked cabinet. Food supply was checked and a 2 day supply of perishable and 7 day supply of non-perishable was checked. Water temperature was measured at 114 degrees F in the bathroom. Linens and resident's hygiene were observed. Fire extinguisher/smoke detectors and buildings and grounds were checked and observed to be operational.

A sample of resident's and staff's files were checked. Resident's files have signed Admission Agreements and Personal Rights. Staff's files are fingerprinted clear and associated and have current CPR.

No deficiency cited for this visit.

Exit interview conducted with Licensee Ritchie Espiridion, and a copy of this report provided.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2024
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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