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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208998
Report Date: 10/12/2023
Date Signed: 10/12/2023 11:08:30 AM

Document Has Been Signed on 10/12/2023 11:08 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:DEL MUNDO HOMEFACILITY NUMBER:
107208998
ADMINISTRATOR:DEL MUNDO, ROSALIEFACILITY TYPE:
735
ADDRESS:867 OXFORD AVETELEPHONE:
(559) 797-4977
CITY:CLOVISSTATE: CAZIP CODE:
93612
CAPACITY: 4CENSUS: 3DATE:
10/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Rosalie Del MundoTIME COMPLETED:
11:20 AM
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
Licensing Program Analyst (LPA) M. Flores arrived unannounced to conduct an annual visit. LPA introduced self, stated the purpose of the visit, and was greeted by Licensee, Rosalie Del Mundo. Two clients were present during this inspection. LPA conducted interviews with staff and client.

The tour started in the living room, to the client's bedrooms, bathroom and kitchen area. The facility was observed to be at a comfortable temperature of degrees 72 degrees F, clean, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. An adequate supply of perishable and non-perishable food was observed. Cleaning supplies and chemicals stored and locked in the laundry room. Medications and sharps observed and kept locked in the kitchen area. All four bedrooms were observed to have required furnishings and with adequate lightening. LPA observed four single rooms. Bathrooms were properly equipped, and the hot water temperature was tested at 119.3 degrees F. Fire extinguisher was observed with a service date of 07/26/23. Fire drill last completed on 09/02/23. Outside of facility toured and observed to be free of debris. Carbon monoxide and smoke detectors were tested and observed to be operational. Staff and client’s files were reviewed. First Aid checked and fully stocked.

No deficiencies issued during this inspection. Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by Administrator. Forms requested: LIC308, LIC 309, LIC 400, LIC 402, LIC 500, LIC 610D, LIC 9282 and submitted by 10/19/23. A copy of this report was provided to the Licensee, whose signature on this form confirms receipt of this report.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Miriam Flores
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2023
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