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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208983
Report Date: 12/09/2021
Date Signed: 12/10/2021 01:34:29 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:SOMERFORD PLACE-FRESNOFACILITY NUMBER:
107208983
ADMINISTRATOR:FOWLER, JENNIFERFACILITY TYPE:
740
ADDRESS:6075 N. MARKSTELEPHONE:
(559) 446-6226
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY:64CENSUS: 28DATE:
12/09/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Beronica Galindo - Business Office ManagerTIME COMPLETED:
11:10 AM
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Licensing Program Analyst (LPA) arrived at facility unannounced to conduce a required annual inspection. LPA met with Business Office Manager Beronica Galindo and announced the purpose of the inspection.

LPA toured the facility inside and outside. All passageways and exits were clear and free from obstruction. Exterior doors were armed with auditory alert devices. Facility was at a comfortable temperature, adequately furnished, and well lit. Kitchen and dining areas were clean. Cleaning supplies and chemical were in locked cabinets. All medication carts were locked and attended by staff. A sufficient supply of perishable and non-perishable food stuffs was observed. A sufficient supply of personal protective equipment, medical supplies, and incontinence supplies was observed. Facility had multiple complete first-aid kits. LPA reviewed inflectional practices and protocols. No deficiencies were cited during the inspection. Exit interview conducted. A copy of the report was provided to the licensee via email.
SUPERVISOR'S NAME: Andy XiongTELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: David AyersTELEPHONE: (559) 650-7925
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2021
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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