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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209035
Report Date: 09/30/2024
Date Signed: 09/30/2024 04:42:23 PM


Document Has Been Signed on 09/30/2024 04:42 PM - 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:TRUEWOOD BY MERRILL, CLOVISFACILITY NUMBER:
107209035
ADMINISTRATOR:MAZON, PAMELAFACILITY TYPE:
740
ADDRESS:675 W ALLUVIAL AVENUETELEPHONE:
(559) 325-8400
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY:148CENSUS: DATE:
09/30/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Administrator (Admin) Pamela MazonTIME COMPLETED:
04:30 PM
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During a Complaint visit, a Case Management Health & Safety check was conducted by Licesnsing Program Analyst (LPA) K. McClurg. Assisting with visit: Administrator (Admin) Pamela Mazon.


Physical plant toured. Facility temperature was comfortable. Furnishings appeared sufficient with adequate lighting. Facility appeared to be clean with no unpleasant odors.
Passageways were clear with no obstructions. Fire extinguisher service date: 11/17/23.
Fire & carbon monoxide detectors present & operational.
Residents observed in activity room playing bingo. Residents appeared to be groomed & appropriately dressed.


No health & safety concerns observe during this visit.

Exit interview conducted with Admin. Report provided.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) 580-4596
LICENSING EVALUATOR NAME: Kelly J. McClurgTELEPHONE: (559) 246-0435
LICENSING EVALUATOR SIGNATURE:
DATE: 09/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/30/2024
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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