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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107204117
Report Date: 04/22/2022
Date Signed: 04/22/2022 12:04:18 PM

Document Has Been Signed on 04/22/2022 12:04 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:REYES RANCH LLCFACILITY NUMBER:
107204117
ADMINISTRATOR:JOSE DE LA CUEVAFACILITY TYPE:
735
ADDRESS:20022 EAST AMERICAN AVETELEPHONE:
(559) 637-0364
CITY:REEDLEYSTATE: CAZIP CODE:
93654
CAPACITY: 4CENSUS: 3DATE:
04/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Jose De La CuevaTIME COMPLETED:
11:40 AM
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On 04/22/22, Licensing Program Analyst (LPA) M. Medina arrived at the above facility unannounced to conduct an Infection Control Inspection. LPA was met Administrator, Jose De La Cueva. LPA observed staff, visitor, and resident log-in/temperature check upon entry.

All residents were at day program during today's inspection. Facility appeared cleaned with no obstruction or fire clearance issues. Hand sanitizer was available to residents and visitors. Social distancing is maintained in the common and dining areas. Bathrooms were stocked with paper towels and liquid soap. Hand washing posters observed in the kitchen area and near the bathroom sink. Bedrooms were checked. Facility bedrooms are single occupant.



LPA observed medication to be locked and secured. Food supply was checked and there appeared to be an adequate food available for the residents in care. Cleaning and PPE supplies were checked, all items are locked and secured in staff office. Fire extinguisher present with a service date of 1/06/22. Smoke detectors and carbon monoxide detectors observed operational during today's inspection.

Jose De La Cueva serves as facility Administrator, Certificate #6033212735, expires 1/12/23. CPR/First Aid expires 2/18/21.

LPA received copies of Administrator Certificate, CPR/First Aid, LIC 308, LIC 309, LIC 500, LIC 610D, LIC 9020, LIC 9148, Surety Bond, and Neighborhood Complaint Policy.

No deficiencies observed during today's inspection. Exit interview conducted. A copy of signed report given to Administrator at conclusion of inspection.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 04/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/22/2022
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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