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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208921
Report Date: 05/28/2021
Date Signed: 05/28/2021 03:35:46 PM

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:HARMONY CARE HOMES LLCFACILITY NUMBER:
107208921
ADMINISTRATOR:WOODALL, HAROLDFACILITY TYPE:
740
ADDRESS:8561 N CALAVERAS AVETELEPHONE:
(559) 284-9076
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY:6CENSUS: 0DATE:
05/28/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Harold Woodall-LicenseeTIME COMPLETED:
11:15 AM
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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 Licensee Harold Woodall and announced the purpose of the visit.

LPA toured the facility inside and outside. All passageways and exits were clear and free from obstruction. LPA and Licensee reviewed infection control guidelines and best practices. There were no residents currently residing in the facility.

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

SUPERVISOR'S NAME: Andy XiongTELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: David AyersTELEPHONE: (559) 650-7925
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2021
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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