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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107204117
Report Date: 06/17/2022
Date Signed: 06/17/2022 10:15:03 AM

Document Has Been Signed on 06/17/2022 10:15 AM - 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: 4DATE:
06/17/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:53 AM
MET WITH:Jose De La CuevaTIME COMPLETED:
10:25 AM
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On 6/17/22, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Case Management to follow up on two incidents reported to Department on 5/25/22 involving R1 and another reported to Department on 6/15/22 involving R2.

LPA obtained copies of IPP's, reviewed resident files and conducted interviews.

No deficiencies cited.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 06/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2022
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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