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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209128
Report Date: 04/20/2021
Date Signed: 04/21/2021 09:25:10 AM

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:A PLACE CALLED HOME RESIDENTIAL 7FACILITY NUMBER:
107209128
ADMINISTRATOR:MURCHISON, COLINFACILITY TYPE:
740
ADDRESS:2238 MONTANA AVETELEPHONE:
(559) 213-7251
CITY:CLOVISSTATE: CAZIP CODE:
93619
CAPACITY:6CENSUS: 0DATE:
04/20/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:59 AM
MET WITH:Colin MurchisonTIME COMPLETED:
11:00 AM
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On or about today's date and due to the Covid-19, LPA, Les Xiong did a televisit inspection at the above facility for an announced Pre-licensing visit. LPA met with Colin Murchinson, Administrator.

Contact Phone number is (559) 213-7251 email: colin@apchcare.com


LPA televisit was conducted for the above facility. Common rooms have adequate furnishings and lighting. All of the resident bedrooms have adequate lighting. Hot water temperature is measured at 115 degrees. LPA observed a supply of extra bed linens and personal hygiene and grooming products. Kitchen observed to ready for food storage and preparation. Medications will be kept in a locked storage/medication room. First aid kit contains all the required items. A fire extinguisher is present and up to date. Smoke detectors/carbon monoxide were present and functional.

No hazards were observed.

Component 3 orientation was conducted during this visit. All required postings are posted.

I have found that applicant has met all pre-licensing requirements. LPA will submit the application for further processing.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Les XiongTELEPHONE: (559) 410-1772
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2021
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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