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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
107209035
Report Date:
10/01/2024
Date Signed:
10/01/2024 02:55:16 PM
Document Has Been Signed on
10/01/2024 02:55 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
FRESNO RO
,
1314 E SHAW AVE
FRESNO
,
CA
93710
FACILITY NAME:
TRUEWOOD BY MERRILL, CLOVIS
FACILITY NUMBER:
107209035
ADMINISTRATOR:
MAZON, PAMELA
FACILITY TYPE:
740
ADDRESS:
675 W ALLUVIAL AVENUE
TELEPHONE:
(559) 325-8400
CITY:
CLOVIS
STATE:
CA
ZIP CODE:
93611
CAPACITY:
148
CENSUS:
DATE:
10/01/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
02:30 PM
MET WITH:
Administrator: Pamela Mazon
TIME COMPLETED:
03:30 PM
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On 10/1/24 LPA J. Leffall conducted a visit to return R1's file that was obtained 9/30/24. LPA met with Administrator (A1) Pamela Mazon and file was given to her. Exit interview conducted.
SUPERVISOR'S NAME:
See Moua
TELEPHONE:
(559) 580-4596
LICENSING EVALUATOR NAME:
Jacques Leffall
TELEPHONE:
559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE:
10/01/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/01/2024
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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