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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209414
Report Date: 05/07/2024
Date Signed: 05/08/2024 07:15:32 AM

Document Has Been Signed on 05/08/2024 07:15 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:SENIOR CARE COMFORT LIVING #2FACILITY NUMBER:
547209414
ADMINISTRATOR/
DIRECTOR:		PIRA, JOSE JR.FACILITY TYPE:
740
ADDRESS:4043 WEST CLINTON AVETELEPHONE:
(559) 802-3459
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY: 6CENSUS: 0DATE:
05/07/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Jose Pira, Licensee/Administrator TIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 05/07/24, Licensing Program Analyst (LPA) L. Salazar arrived at the facility for an announced pre licensing inspection. LPA was greeted by Licensee/Administrator and was allowed entry into the facility.

LPA toured the facility inside and out with licensee. LPA entered through the front door and did observed the required postings in the entry. LPA observed the residence to be a single story, 4 bedroom/ 2 bathroom home. There is a dining room and living room observed to have adequate furnishings and lighting. All bedrooms were observed to have beds, personal lighting and chest drawers to accommodate 2 residents per room.

LPA observed fire extinguisher to be new and charged with a service date of 04/2024. Smoke detectors were tested and observed to be operational. Carbon Monoxide detector was observed in the kitchen. Emergency lighting /flashlights and night lights in the hallways by the bathrooms were observed.

LPA observed a adequate supply of towels. Hand washing signs observed. A supply of paper towels were observed in the bathrooms. Hot water temperature in bathroom measured at 107.4 degrees F. Non-Skid mats were not present in the shower. Grab bars were observed in resident bathroom, however, the staff / visitor bathroom, licensee will install.

Kitchen observed to have supply of dishes, plates, pots and pans. Food storage and preparation areas are clear and appropriate for food preparation. Cleaning supplies and chemicals are locked in the garage. A locked cabinet in the kitchen is designated to store medications. Sharps/knives were observed in a locked drawer in the kitchen. Appliances observed to be in working order. LPA observed a 7 day supply of non-perishable food.
(continued on LIC809-C)
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/07/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: SENIOR CARE COMFORT LIVING #2
FACILITY NUMBER: 547209414
VISIT DATE: 05/07/2024
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(Continued from LIC 809)

First aid kit was observed. Washer and Dryer observed in the laundry room with additional storage space available in upper cabinets. Doors and passageways are clear and free from obstruction throughout the home. LPA toured the outside of the residence and observed a covered patio with a adequate outdoor seating for activities. A self-latching gate found to be working properly. There are no bodies of water on the premises.


The following observed will need to be brought into compliance:

Dust ceiling fans in bedrooms
Touch up paint for baseboards, wall trim and bedroom door trims throughout the house,
Posting of Ombudsman poster and visiting Policy
Remove posters on walls from previous facility
Fill in screw holes in bedrooms
Paint or clean entry doorways and doors
New trash can for room 101
Provide internet device for resident's telecommunications use
Update the emergency disaster plan (LIC 610D) to reflect specific steps of what the facility will do in the event of an emergency disaster - specifically page 2, 4, 5.

An exit interview was conducted and a copy of this report was left with licensee, whose signature confirms receipt of these documents.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024
LIC809 (FAS) - (06/04)
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