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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107202573
Report Date: 11/20/2024
Date Signed: 11/21/2024 12:08:29 PM

Document Has Been Signed on 11/21/2024 12:08 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:REEDLEY HOMEFACILITY NUMBER:
107202573
ADMINISTRATOR/
DIRECTOR:		LUPE MARTINEZFACILITY TYPE:
735
ADDRESS:3461 S. USRY AVENUETELEPHONE:
(559) 638-6640
CITY:REEDLEYSTATE: CAZIP CODE:
93654
CAPACITY: 6CENSUS: 6DATE:
11/20/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:38 PM
MET WITH:Dale Martinez, Administrator
Lupe Martinez, Licensee		TIME VISIT/
INSPECTION COMPLETED:
05:56 PM
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On 11/20/24, Licensing Program Analysts (LPAs) L. Salazar and M. Garza arrived to the facility unannounced to conduct the required annual inspection. LPAs were greeted by staff, stated the purpose of the visit and were allowed entry into the facility. Administrator was contacted and arrived to the facility a short time after. LPA Salazar will conduct the staff and resident file reviews and document on this report. LPA Garza will conduct the facility tour and document the facility operations on a separate report.

LPA observed 6 out of 6 resident records to have the required licensing forms. A sample of staff records were reviewed and observed to the have the required forms and training. Disaster Plan was observed to be completed.

Exit interview conducted with Administrator and Licensee. No deficiencies cited on today's visit.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/20/2024
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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