<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208859
Report Date: 07/18/2024
Date Signed: 07/18/2024 04:33:56 PM

Document Has Been Signed on 07/18/2024 04:33 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:CORPUZ ADULT RESIDENTIAL FACILITY INCFACILITY NUMBER:
107208859
ADMINISTRATOR/
DIRECTOR:
CORPUZ, JIMENAFACILITY TYPE:
735
ADDRESS:1536 BARSTOW AVENUETELEPHONE:
(559) 472-3470
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY: 6CENSUS: 6DATE:
07/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:20 PM
MET WITH:Jimena CorpuzTIME VISIT/
INSPECTION COMPLETED:
04:35 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 7/18/2024, Licensing Program Analysts (LPAs) M. Medina and D. Boyd conducted an unannounced Annual Required inspection. LPAs introduced self, stated purpose of visit and allowed entrance by Administrator, Jimena Corpuz.

Facility tour conducted with Administrator. All residents arrived from day program during facility inspection. Residents observed to be interacting with staff after arrival from day program. Facility observed to be clean and odor free, well lit, and have adequate seating throughout facility for all residents. Resident bedrooms toured and observed to have required furnishings available. Kitchen toured, facility observed to have adequate supply of food available for residents in care. All knives are locked in a safe and secured in a locked cabinet. All stove knobs have been removed for safety of residents. Resident bathrooms toured, and fixtures observed operational during inspection. Hot water measured at 111 degrees F during facility inspection.

Fire Extinguisher present with a service date of 7/03/2024. Carbon monoxide and smoke detectors tested and observed operational during today's inspection. Facility records indicate the last fire drill was conducted on 06/01/2024.

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

No deficiencies observed during facility inspection.

Exit interview conducted. A copy of signed report provided for facility records.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/18/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1