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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547206803
Report Date: 08/10/2022
Date Signed: 08/10/2022 03:16:40 PM

Document Has Been Signed on 08/10/2022 03:16 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:SEARCY HOMEFACILITY NUMBER:
547206803
ADMINISTRATOR:SEARCY, KIMBERLYFACILITY TYPE:
740
ADDRESS:2482 CRICKELWOOD CTTELEPHONE:
(559) 781-0952
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY: 4CENSUS: 4DATE:
08/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Kimberly SearcyTIME COMPLETED:
03:31 PM
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On 8/10/22, Licensing Program Analysts (LPAs) M. Medina and B. Miranda conducted an unannounced Annual Required Infection Control Inspection. LPAs allowed entrance by Licensee Kimberly Searcy. Kimberly Searcy also serves as facility Administrator, Certificate #6024767740, expires 4/04/2024. LPA observed sign-in sheet, thermometer, and hand sanitizer available. Front door serves as facility main entrance.

Facility observed to at comfortable temperature. All resident bedrooms toured, all rooms are private. Resident bathroom toured, LPAs observed hand washing sign posted, hand soap and paper towels available. Kitchen toured, facility has adequate food supply for residents in care. Knives are locked and secured in utility box. Medication is locked and secured in pantry. Smoke detector and carbon monoxide detector observed operational during today's inspection. Fire extinguisher has a service date of 03/01/2022.

Outside of facility toured. No obstructions observed. Spa has cover that is locked, secured, and inaccessible to residents.

No deficiencies observed during today's inspection.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 08/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/10/2022
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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