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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206609
Report Date: 10/14/2021
Date Signed: 10/14/2021 11:31:18 AM

Document Has Been Signed on 10/14/2021 11:31 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:GETTYSBURG CHRISTIAN HOMEFACILITY NUMBER:
107206609
ADMINISTRATOR:DYER, ELIZABETHFACILITY TYPE:
740
ADDRESS:4844 E. GETTYSBURGTELEPHONE:
(559) 294-9080
CITY:FRESNOSTATE: CAZIP CODE:
93726
CAPACITY: 18CENSUS: 11DATE:
10/14/2021
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
11:22 AM
MET WITH:Staff, Joyce TorresTIME COMPLETED:
11:31 AM
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Licensing Program Analyst (LPA) Darius Williams conducted an unannounced Case Management visit. LPA Williams met with Staff, Joyce Torres and discussed the purpose of the visit. LPA Williams also spoke with Administrator Elizabeth Dyer via phone and discussed the purpose of the visit.

The Licensee does not currently have a Covid-19 Mitigation Plan (LIC 808) on file.

LPA Williams discussed the expectation of the Covid-19 Mitigation Plan with the Administrator and provided a blank copy via e-mail.

Administrator agreed to submit the Covid-19 Mitigation Plan to Community Care Licensing Division by 10/21/2021.

No deficiency cited.

An exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Darius Williams
LICENSING EVALUATOR SIGNATURE: DATE: 10/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/14/2021
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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