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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206752
Report Date: 09/04/2020
Date Signed: 09/14/2020 10:19:57 AM

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:DIAL FOR CAREFACILITY NUMBER:
107206752
ADMINISTRATOR:SHAMEKA TURNERFACILITY TYPE:
740
ADDRESS:1594 E. LOS ALTOSTELEPHONE:
(559) 704-6467
CITY:FRESNOSTATE: CAZIP CODE:
93710
CAPACITY:6CENSUS: 6DATE:
09/04/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:07 PM
MET WITH:Shameka Turner, AdministratorTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Lady Cabrera contacted Administrator Shameka Turner.

The purpose of the case management phone call is to follow-up on the health and safety check of Resident 1 (R1) and to obtain additional information. The incident occurred on 08/31/2020 and it was reported to Community Care Licensing on 08/31/2020.

SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Lady CabreraTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2020
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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