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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208825
Report Date: 12/14/2024
Date Signed: 12/14/2024 01:29:31 PM

Document Has Been Signed on 12/14/2024 01:29 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:FAMILY IS WHYFACILITY NUMBER:
107208825
ADMINISTRATOR/
DIRECTOR:		SEJA, HEIDIFACILITY TYPE:
740
ADDRESS:2495 S. RABETELEPHONE:
(334) 652-9491
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 3DATE:
12/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:18 AM
MET WITH:DeAngela SantosTIME VISIT/
INSPECTION COMPLETED:
01:35 PM
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On 12/12/2024, Licensing Program Analyst (LPA) M Medina conduced an unannounced Annual Required inspection. LPA arrived, introduced self, stated purpose of visit and allowed entrance by Licensee. LPA conducted facility tour with DeAngela Santos, Licensee.

Currently, there are three (3) residents in care. All were present at time of inspection. LPA observed facility to be clean, odor free, and a comfortable temperature. Facility is 4 bedrooms and 2 bathroom. .

Facility tour conducted with Licensee. All common areas have adequate seating available for all residents in care. Kitchen toured, LPA observed facility to have a 2-day supply of perishable and a 7-day of non-perishable food available. LPA observed all food to be properly stored and dated. LPA observed stove knobs to be removed and secured. All knives and sharps were also observed to be locked and secured. All resident bedrooms toured, bedrooms observed to have all required accommodations available. Resident bathrooms toured. LPA observed fixtures to be operational during inspection. LPA observed grab bars, non-skid mats, and grab bars in the shower/tub areas, as well as near toilets. Water temperature measured at 115 degrees F. Medications observed to be locked and secured. LPA observed medications to have original labels and to be administered as prescribed.

Cleaning supplies observed to be locked and secured in laundry room cabinet. Fire extinguishers present with a purchase date of 1/02/2024. Last fire drill conducted 12/06/24, last disaster drill conducted 11/08/24 according to facility records. Carbon monoxide detectors and smoke detectors observed operational at time of inspection.

Outside of facility toured. All exits open free of obstruction. No hazards observed.

Resident and staff files reviewed. A copy of this signed report will be provided to Licensee via e-mail for their records.

No deficiencies cited.
Melinda HoffmannTELEPHONE: (559) 341-3247
Melinda MedinaTELEPHONE: (559) 410-5914
DATE: 12/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2024
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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