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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543801694
Report Date: 07/09/2021
Date Signed: 07/09/2021 12:53:47 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:FAMILY F.O.C.U.S.FACILITY NUMBER:
543801694
ADMINISTRATOR:TANNER, PRUDY JFACILITY TYPE:
830
ADDRESS:1504 S. KESSINGTELEPHONE:
(559) 784-2214
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY:45CENSUS: 13DATE:
07/09/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Twila Silva, Site SupervisorTIME COMPLETED:
01:00 PM
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On 07/09/2021, LPA Pete Espinoza conducted a Case Management visit for the purpose of obtaining signatures and delivery of amended report that supersedes the Complaint Investigation Report and citation issued on 05/18/2021. LPA Met with Twila Silva, Site Supervisor. LPA informed Ms. Silva the reason for visit and toured the facility both inside and outside as shown on facility sketch. Census was taken.

NO DEFICIENCIES OBSERVED IN THE AREAS INSPECTED DURING TODAY’S VISIT.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.

To order forms, etc. visit our website at www.ccld.ca.gov.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Peter EspinozaTELEPHONE: 661-644-8231
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021
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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