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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209169
Report Date: 09/24/2021
Date Signed: 09/24/2021 02:16:19 PM

Document Has Been Signed on 09/24/2021 02:16 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:CARING ANGELSFACILITY NUMBER:
107209169
ADMINISTRATOR:ALCAREZ, RACHELFACILITY TYPE:
735
ADDRESS:1689 SUSSEX AVENUETELEPHONE:
(559) 287-3472
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY: 6CENSUS: 0DATE:
09/24/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Licensee Swellen Medroso and Administrator Rachel AlcarazTIME COMPLETED:
02:30 PM
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On 09/24/21 at approximately 12:00 PM Licensing Program Analysts (LPA) Shawna Doucette and Mai Yang arrived to the facility announced to conduct the Pre licensing visit. LPA Shawna Doucette and Mai Yang met with Licensee Swellen Medroso and Administrator Rachel Alcaraz who granted LPA's entry into the facility.

LPA toured facility. Common rooms have adequate furnishings and lighting. All of the resident bedrooms have all the required furnishings and adequate lighting. Hot water temperature in bathrooms measured at 118 degrees F. LPA observed a supply of extra bed linens and personal hygiene and grooming products. Kitchen observed to have dishes, plates, utensils. Cleaning supplies are stored in a locking cabinet in the garage. Medications are locked in a medication cabinet in kitchen. First aid kit contains all the required items. A fire extinguisher is present and has a service date of 07/29/21. Smoke detectors and carbon monoxide were operating properly.

Outside of the facility toured. The facility pool is gated and locked inaccessible to clients. Exits open free of obstruction. No outside hazards were observed. Facility has seating area for clients.

Facility phone number will be (559) 374-5109.

Component III was conducted during pre-licensing visit with Applicants.

I have found that applicant has met all pre licensing requirements. LPA will submit documentation to CAB in Sacramento for final review prior to license being issued.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 09/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/24/2021
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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