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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100405566
Report Date: 01/28/2025
Date Signed: 01/28/2025 11:12:42 AM

Document Has Been Signed on 01/28/2025 11:12 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:PRINCE & PRINCESS HOME FOR THE ELDERLYFACILITY NUMBER:
100405566
ADMINISTRATOR/
DIRECTOR:
PRINCE, BETTYFACILITY TYPE:
740
ADDRESS:4686 E CORTLANDTELEPHONE:
(559) 231-5728
CITY:FRESNOSTATE: CAZIP CODE:
93726
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
01/28/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Licensee: Betty PrinceTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 1/28/25 Licensing Program Analysts (LPA) J. Leffall and K. McClurg conducted a follow-up POC visit to review deficiencies made on annual visit conducted on 1/14/25. 1 resident was present during visit. All other 3 residents were attending day program. The purpose of the visit is to review if deficiencies have been cleared. The following deficiencies have not been cleared by POC date. They include:

-Medication Training

Licensee agrees to provide completed medication training in writing by 1/30/25.

All other deficiencies previously cited during annual visit on 1/14/25 have been cleared by CCLD.

Exit interview conducted. A copy of this report was provided to Licensee, whose signature on this form confirms receipt of this report.
See MouaTELEPHONE: (559) 580-4596
Jacques LeffallTELEPHONE: 559-243-8080
DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/28/2025
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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