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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547206954
Report Date: 04/21/2022
Date Signed: 04/21/2022 12:33:53 PM

Document Has Been Signed on 04/21/2022 12:33 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:PRICE ELDERLY LLC 2FACILITY NUMBER:
547206954
ADMINISTRATOR:PRICE, SHELBYFACILITY TYPE:
740
ADDRESS:585 W KANAI AVETELEPHONE:
(559) 359-1184
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY: 6CENSUS: 4DATE:
04/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Shelby PriceTIME COMPLETED:
12:43 PM
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On 4/21/2022, LPA conducted an unannounced Annual Required Inspection. LPA met with Licensee/Administrator, Shelby Price and stated the purpose of the visit. A tour of the facility was conducted. 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 side entrance near garage.

Facility appeared clean with no obstruction or fire clearance issues. Hand sanitizer was readily available to resident and visitors. Social distancing is maintained in the common and dining areas. Bathrooms have trash cans with lid. Hand washing posters were observed by the bathroom sink. Resident bedrooms toured, resident bedrooms with 2 occupants observed to have a minimum of 6 feet between beds.

Fire extinguisher present and has a service date of 03/14/2022. Carbon monoxide detector and smoke detectors present and observed to be operational during today's inspection.

Food supply was observed to be adequate for residents in care. Cleaning and PPE supplies were checked.

No deficiencies observed during inspection. Exit interview conducted. LPA left copy of facility report with licensee.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 04/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21/2022
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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