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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209000
Report Date: 02/26/2021
Date Signed: 02/26/2021 01:13:14 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:LAURITE SENIOR CARE HOMEFACILITY NUMBER:
107209000
ADMINISTRATOR:DAVIS, MARITAFACILITY TYPE:
740
ADDRESS:5478 E LAURITE AVETELEPHONE:
(559) 246-1561
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY:6CENSUS: 3DATE:
02/26/2021
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
08:51 AM
MET WITH:Marita Davis, Administrator TIME COMPLETED:
08:52 AM
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Licensing Program Analyst (LPA) S. Moua conducted a Health & Safety case management inspection on this date. Inspection was conducted via Televisit due to COVID-19 precautionary measures. Inspection was conducted in conjunction with opening a complaint.

Facility was toured. Residents were observed. There appears to be sufficient supply of perishable and non-perishable food.

No immediate health or safety concerns were observed.

Exit Interview was conducted.
SUPERVISOR'S NAME: Andy XiongTELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: See MouaTELEPHONE: (559) 650-7904
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2021
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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