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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107200719
Report Date: 09/27/2023
Date Signed: 09/27/2023 02:45:33 PM


Document Has Been Signed on 09/27/2023 02:45 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:VALLEY CHRISTIAN HOME IIFACILITY NUMBER:
107200719
ADMINISTRATOR:GAMUEDA, HONORAFACILITY TYPE:
740
ADDRESS:504 W. MESATELEPHONE:
(559) 438-1009
CITY:FRESNOSTATE: CAZIP CODE:
93704
CAPACITY:6CENSUS: 4DATE:
09/27/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:01 PM
MET WITH:Facility Staff, Nancy MarianoTIME COMPLETED:
03:00 PM
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On 09/27/2023, Licensing Program Analysts (LPAs) Walton and Padgett arrived unannounced to conduct a POC visit. LPAs introduced themselves, stated the purpose of the visit and requested to meet with the Administrator. Facility staff contacted Administrator, Honora Gamueda via telephone. LPAs received verbal permission to meet with facility staff, Nancy Mariano. Administrator, Honora Gamueda arrived a short time later.

During today's visit, LPAs measured the hot water in bathroom 1 and bathroom 2 and reviewed records. Hot water measured at 108.5 degrees F in bathroom 1 and 107.3 degrees F in bathroom 2.

No deficiencies issued during today's inspection.

Exit interview conducted. A copy of this report was discussed and provided to Administrator, Honora Gamueda, whose signature on this form confirms receipt of this document.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2023
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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