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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209029
Report Date: 02/15/2022
Date Signed: 02/15/2022 10:52:59 AM

Document Has Been Signed on 02/15/2022 10:52 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:TODD FAMILY HOMEFACILITY NUMBER:
547209029
ADMINISTRATOR:TODD, TAMERAFACILITY TYPE:
740
ADDRESS:22755 AVE 178TELEPHONE:
(559) 784-2267
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY: 4CENSUS: 4DATE:
02/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:19 AM
MET WITH:Michael Todd
Tamera Todd		TIME COMPLETED:
10:59 AM
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Licensing Program Analyst (LPA) M. Medina conducted an Annual Required-Infection Control Inspection on this date. LPA was met by Licensees Michael and Tamera Todd and stated the purpose of the visit. LPA observed COVID-19 guidelines to be in place. Visitor log-in/temperature check was observed upon entry. Facility has one entrance/exit point.

Facility appeared cleaned with no obstruction or fire clearance issues. Hand sanitizer was readily available to residents 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 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 food and a 7-day supply of non-perishable food available in facility. Cleaning and PPE supplies were checked.

LPA received copies of Administrator Certificate, cpr/first aid and LIC 9020 during facility inspection. Administrator to submit updated LIC 500, LIC 610/LIC 610E, LIC 9020 to Fresno CCL office by 2/25/22 .

No deficiencies cited during today's inspection.

Exit interview was conducted. Administrator was informed that as a COVID-19 precautionary measure, this report will be emailed. Report was signed by Administrator during exit interview.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2022
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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