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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107202497
Report Date: 09/22/2021
Date Signed: 09/22/2021 10:44:53 AM

COMPREHENSIVE INSPECTION
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:PACIFICA SENIOR LIVING FRESNOFACILITY NUMBER:
107202497
ADMINISTRATOR:NATASHA HAGOPIANFACILITY TYPE:
740
ADDRESS:1715 E ALLUVIAL AVETELEPHONE:
(559) 298-4900
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:100CENSUS: 79DATE:
09/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Administrator, Eddie RangelTIME COMPLETED:
10:45 AM
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On 09/22/2021, Licensing Program Analyst (LPA) A. Walton arrived unannounced to conduct an Annual Inspection- Infection Control. LPA introduced self, stated the purpose of the visit and requested to speak with the Administrator. LPA met with Administrator, Eddie Rangel.

An Annual Inspection - Infection Control visit was conducted on 06/24/2021. No deficiencies were issued during the inspection. A report was created and provided to Administrator, Eddie Rangel on 06/24/2021.

COVID-19 guidelines continue to be in place at the above facility.

No deficiencies issued during this inspection.

Exit interview conducted. As a COVID-19 precautionary measures, a copy of this report will be provided to Administrator via email and an electronic read receipt confirms receiving this document. Facility Representative signed the report on-site.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021
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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