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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547207158
Report Date: 04/12/2022
Date Signed: 04/12/2022 01:26:40 PM

Document Has Been Signed on 04/12/2022 01:26 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, LLCFACILITY NUMBER:
547207158
ADMINISTRATOR:PRICE, SHELBYFACILITY TYPE:
740
ADDRESS:643 NORTH MAURER STREETTELEPHONE:
(559) 359-1184
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY: 6CENSUS: 6DATE:
04/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:48 AM
MET WITH:Shelby PriceTIME COMPLETED:
01:30 PM
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 4/12/2022, Licensing Program Analyst (LPA) M. Medina conducted an Annual Required Infection Control Inspection. LPA Medina met by Licensee, Shelby Price and stated the purpose of the facility visit. COVID-19 guidelines are in place. Visitor log-in/temperature check was observed upon entry. Facility has one entrance/exit point. Shelby Price, Administrator Certificate #6027486740, expires 7/30/2023.

Tour of the facility conducted. Facility appeared cleaned with no obstruction or fire clearance issues. Hand sanitizer was readily available to residents and visitor. Resident bedrooms toured, resident bedrooms have a minimum of 6 feet between beds.

LPA checked residents’ medications and observed a 30-day supply. LPA observed a 2-day supply of perishable and a 7-day supply of non-perishable food available. Cleaning and PPE supplies were checked. Resident’s files have updated emergency contact information. Fire extinguisher present with a service date of 3/14/2022. LPA observed carbon monoxide detectors and smoke detectors to be operational during today's inspection.

Outside of facility toured. No hazards observed.

No deficiencies were observed. Exit interview was conducted. Facility report signed on site. Administrator was informed that as a COVID-19 precautionary measure, this report will be emailed.

No deficiencies issued during inspection.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2022
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