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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209031
Report Date: 08/31/2021
Date Signed: 08/31/2021 12:00:34 PM

Document Has Been Signed on 08/31/2021 12:00 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:WIGGINS HOME 3FACILITY NUMBER:
547209031
ADMINISTRATOR:BOYD, ELYSIAFACILITY TYPE:
740
ADDRESS:677 S SIERRA STREETTELEPHONE:
(559) 783-0732
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY: 6CENSUS: 6DATE:
08/31/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:41 AM
MET WITH:Elysia BoydTIME COMPLETED:
12:05 PM
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Licensing Program Analyst (LPA) M. Medina arrived at the facility unannounced to conduct the Annual Infection Control Inspection. LPA met with Licensee/Administrator Elysia Boyd.

Upon entry, LPA completed sign in and temperature was taken, facility has one central entry and exit point where hand sanitizer is also available.

Facility Mitigation plan was reviewed. Mitigation plan was approved by Department on 4/21/2021. Infection control procedures described in the plan which were observed or reviewed by LPA include: Daily symptoms screenings (for staff, persons in care and visitors), visitation policy, quarantine/isolation procedures, infection control and disinfecting procedures, staffing plan, PPE storage and use. Administrator, Elysia Boyd is identified as the Infection Control Lead for the facility.

LPA toured the facility inside and out. PPE and hand washing postings were observed in the facility. Staff were all observed wearing face coverings. Facility has designated visitation area for visitors. LPA observed 30 day PPE and medication supply. Sinks are well stocked with liquid soap and paper towels for hand washing. LPA observed daily screening logs of both staff and residents.

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: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2021
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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