<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547204240
Report Date: 05/27/2022
Date Signed: 05/27/2022 11:18:37 AM

Document Has Been Signed on 05/27/2022 11:18 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:ATKINS WAY HOMEFACILITY NUMBER:
547204240
ADMINISTRATOR:TAYLOR, RAYMONDFACILITY TYPE:
740
ADDRESS:1551 N. ATKINS WAYTELEPHONE:
(559) 782-3481
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY: 5CENSUS: 3DATE:
05/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:11 AM
MET WITH:Raymond TaylorTIME COMPLETED:
11:26 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 5/27/202, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required Infection Control Inspection. LPA introduced allowed entrance by Administrator, Raymond Taylor. LPA Medina conducted facility tour and inspection, COVID-19 guidelines are in place. Visitor log-in/temperature check was observed upon entry. Facility has one entrance/exit point, all staff and visitors enter through front door. Facility staff observed to be wearing face masks.

Facility appeared clean with no obstruction or fire clearance issues. Social distancing is maintained in the common and dining areas. Bathrooms have trash cans with lid, hand washing posters observed near sink, paper towels and hand soap available. Resident rooms toured, all rooms are private and observed to have required furnishings. Food supply observed to be adequate for residents in care. Facility observed to have PPE and cleaning supplies stored in laundry room. Medication observed to be locked and secured in hall closet, all residents have a 30-day supply of medication available.

Fire extinguisher present with a service date of 3/09/22. Carbon monoxide and smoke detectors present and observed to be operational during today's inspection. Facility is equipped with pull station.

Administrator to submit copies of current Administrator Certificate, CPR/First Aid, LIC 500, LIC 610 and LIC 9020 to Fresno CCL office no later than 6/10/2022.

No deficiencies observed during today's inspection. Exit interview conducted. Copy of report provided for facility records.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 05/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/27/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1