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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208921
Report Date: 06/07/2021
Date Signed: 06/14/2021 01:34:17 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:
06/07/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Harold Woodall-LicenseeTIME COMPLETED:
12:15 PM
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On this date, Licensing Program Analyst(LPA) D. Ayers arrived at the facility to conduct an announced case management inspection. LPA met with Licensee Harold Woodall.

The purpose of the inspection was to record and finalize the voluntary closure of the facility. LPA conducted a tour of the facility. LPA confirmed that the facility is uninhabited.

Facility closure to be processed with Licensing Program Manager (LPM) approval effective date 6/7/2021. No deficiencies were cited during the inspection. Licensee completed Closure Survey. Exit interview conducted. A copy of the report was emailed to the licensee for signature.
SUPERVISOR'S NAME: Andy XiongTELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: David AyersTELEPHONE: (559) 650-7925
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2021
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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