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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208791
Report Date: 11/18/2024
Date Signed: 11/18/2024 03:38:36 PM

Document Has Been Signed on 11/18/2024 03:38 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:ATLANTA HOMEFACILITY NUMBER:
107208791
ADMINISTRATOR/
DIRECTOR:		MARGARITA NAVALFACILITY TYPE:
734
ADDRESS:2526 WEST ATLANTA AVENUETELEPHONE:
(559) 724-9869
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY: 5CENSUS: 4DATE:
11/18/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:17 AM
MET WITH:Margarita Naval, AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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On 11/18/24, Licensing Program Analysts (LPAs') L. Salazar and M. Garza arrived to the facility unannounced to conduct the required annual inspection. LPAs' were greeted by RN staff, stated the purpose of the visit and were allowed entry into the facility. Administrator arrived to the facility shortly after LPAs' arrival. Administrator on record is Margarita Naval, Certificate #7020552735, Expiration date 10/07/25.

LPAs' observed four (4) residents in care at the time of arrival and 4 staff members present at the facility. Staff observed consisted of two (2) Direct Support Personnel (DSP), a Licensed Vocational Nurse (LVN), and an Registered Nurse (RN).

LPA Salazar reviewed staff and resident file and observed 4 out 4 resident files to have the required documentation and updated forms. LPA observed 4 out of 4 staff files to have the required training and licensing forms in file. LPA Garza conducted the facility tour and documented the facility operations portion of the visit on a separate LIC 809.

Based on LPAs observations of records review, no deficiencies are being cited on today's visit. Exit interview conducted and a copy of this report will be sent via email by next business day. A copy of the read receipt will serve as proof of delivery.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 11/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2024
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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