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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206845
Report Date: 06/22/2021
Date Signed: 06/22/2021 03:05:29 PM

Document Has Been Signed on 06/22/2021 03:05 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:EDDIES TERRACE #4FACILITY NUMBER:
107206845
ADMINISTRATOR:STEPHANIE HENDRICKSFACILITY TYPE:
735
ADDRESS:1415 W. SIERRATELEPHONE:
(559) 439-2513
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY: 6CENSUS: 3DATE:
06/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Maricia Alvarado- Assistant AdministratorTIME COMPLETED:
12:00 PM
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On this date, Licensing Program Analyst(LPA) D. Ayers arrived at the facility unannounced to conduct a required annual inspection. LPA met with Administrator Maricia Alvarado and announced the purpose of the visit.

LPA toured the facility inside and outside. All passageways and exits were clear and free from obstruction. The carbon monoxide and smoke detectors were functioning properly. The facility was adequately furnished. Medications and sharp items were secured in locked cabinets. LPA toured resident bedrooms and bathrooms. All bedrooms and were adequately furnished and lit. Bathrooms were clean, odor free, and fixtures were functional. LPA and Administrator reviewed infection control guidelines and best practices.

No deficiencies were cited during the inspection. Exit interview was conducted. A copy of the report was provided.

SUPERVISORS NAME: Andy Xiong
LICENSING EVALUATOR NAME: David Ayers
LICENSING EVALUATOR SIGNATURE: DATE: 06/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/22/2021
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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