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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
107209027
Report Date:
03/16/2022
Date Signed:
03/18/2022 10:17:29 AM
Document Has Been Signed on
03/18/2022 10:17 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
CCLD Regional Office
,
1314 E SHAW AVE
FRESNO
,
CA
93710
FACILITY NAME:
ASHLEIGH'S HOUSE
FACILITY NUMBER:
107209027
ADMINISTRATOR:
MCBEE, BRENDA R Y
FACILITY TYPE:
735
ADDRESS:
3088 W NORWICH
TELEPHONE:
(559) 273-7193
CITY:
FRESNO
STATE:
CA
ZIP CODE:
93722
CAPACITY:
3
CENSUS:
DATE:
03/16/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
09:00 AM
MET WITH:
TIME COMPLETED:
09:50 AM
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SUPERVISORS NAME
:
Sergiy Pidgirny
LICENSING EVALUATOR NAME
:
Katie Brown
LICENSING EVALUATOR SIGNATURE
:
DATE:
03/16/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
03/16/2022
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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