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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107201450
Report Date: 12/17/2021
Date Signed: 12/17/2021 03:32:38 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:CHRISTINA'S CARE HOMEFACILITY NUMBER:
107201450
ADMINISTRATOR:STEPHEN, RAVIFACILITY TYPE:
740
ADDRESS:2551 MESA AVENUETELEPHONE:
(559) 347-9900
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY:6CENSUS: 6DATE:
12/17/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Ravi Stephen, AdministratorTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) M. Yang conducted unannounced case management visit for the purpose of amending Facility Evaluation Report dated 12/3/21. LPA announced reason for visit to Ravi Stephen, Administrator. Administrator was informed that as COVID-19 precautionary measure, this report will be provided via email. Report signed on-site.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 243-8080
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
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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