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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547207158
Report Date: 05/18/2023
Date Signed: 05/18/2023 02:35:20 PM

Document Has Been Signed on 05/18/2023 02:35 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:
05/18/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
11:31 AM
MET WITH:Shelby PriceTIME COMPLETED:
12:37 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
I was at the above facility conducting an unannounced case management-annual continuation started on 5/16/23.

Mitigation plan has been submitted Licensing. Infection control procedures described in the plan and observed by LPAs include: Daily symptoms screenings (for staff, persons in care and visitors), visitation policy, quarantine/isolation procedures, surveillance testing, infection control plan and identification of Shelby Price as the Infection Control Lead, emergency staffing, PPE use, infection control training and procedures, documentation, postings and communication. LPAs reviewed Mitigation Plan and procedures with the House manager and Administrator.


Through LPA’s observations, documentation review and interview with Administrator, the required infection control practices are found to be in compliance. No deficiencies cited on today’s inspection.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Les Xiong
LICENSING EVALUATOR SIGNATURE: DATE: 05/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/18/2023
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