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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209303
Report Date: 01/13/2025
Date Signed: 01/13/2025 03:48:55 PM

Document Has Been Signed on 01/13/2025 03:48 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:PSALMS 23 LOVING CARE RESIDENTIAL IIIFACILITY NUMBER:
107209303
ADMINISTRATOR/
DIRECTOR:		COOLEY, I'ISHAFACILITY TYPE:
735
ADDRESS:441 W ALLUVIAL AVETELEPHONE:
(559) 270-3822
CITY:PINEDALESTATE: CAZIP CODE:
93650
CAPACITY: 4CENSUS: 2DATE:
01/13/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Administrator - I'isha CooleyTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On 01/13/24, Licensing Program Analyst (LPA) M Vega arrived at the facility unannounced to conduct a case management visit. LPA was greeted by Administrator - I'isha Cooley, stated the purpose of the visit, and was allowed entry into the facility.

LPA Amended reports: LIC 9099, LIC 9099C and LIC 9099D

Based on records review and per California Code of Regulations, Title 22, Division 6, Chapter 8, an amended deficiency is being attached LIC 9099D appeal rights are also provided to administrator

Exit interview was conducted and a printed copy of this report and appeal rights were provided to Administrator - I'isha Cooley.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Martin Vega
LICENSING EVALUATOR SIGNATURE: DATE: 01/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/13/2025
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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