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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100404809
Report Date: 02/10/2022
Date Signed: 02/10/2022 01:41:48 PM

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:PALM VILLAGE RETIREMENT COMMUNITYFACILITY NUMBER:
100404809
ADMINISTRATOR:JIM HIGBEEFACILITY TYPE:
741
ADDRESS:703 WEST HERBERT AVENUETELEPHONE:
(559) 638-6933
CITY:REEDLEYSTATE: CAZIP CODE:
93654
CAPACITY:262CENSUS: 168DATE:
02/10/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:08 PM
MET WITH:Jim Higbee
Karely Alcantar		TIME COMPLETED:
01:39 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
On 2/10/22, Licensing Program Analyst (LPA) M. Medina conducted a Case Management visit for the purpose of conducting a pre-licensing inspection for a home to be included in the Palm Village Retirement Community.

LPA received the fire clearance on 1/26/22 which was granted by Reedley Fire Department. Fire clearance was granted for an additional 2 residents to occupy the dwelling.

LPA toured the additional living space on property. The additional home is properly furnished for the increase of 2 residents. The home has a fire extinguisher with a date of service of 1/18/22, LPA observed smoke detector and carbon monoxide detectors to be operational during pre-licensing inspection. Water temperature measured at 112 degrees F.

LPA is in agreement with the residence to be included in the Palm Village Retirement Community. The dwelling to be included will not increase overall capacity of the facility.

No deficiencies observed.

Exit interview was conducted and report was signed. Administrator was informed that as a COVID-19 precautionary measure, this report will be emailed.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2022
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