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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209306
Report Date: 07/11/2023
Date Signed: 07/11/2023 03:35:13 PM

Document Has Been Signed on 07/11/2023 03:35 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:PSALMS 23 LOVING CARE RESIDENTIAL IIIIFACILITY NUMBER:
107209306
ADMINISTRATOR:COOLEY, I'ISHAFACILITY TYPE:
735
ADDRESS:2210 S EUNICE AVETELEPHONE:
(559) 270-3822
CITY:FRESNOSTATE: CAZIP CODE:
93706
CAPACITY: 4CENSUS: 0DATE:
07/11/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:17 PM
MET WITH:Administrator, I'isha CooleyTIME COMPLETED:
03:48 PM
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07/11/2023, Licensing Program Analyst (LPA) Walton conducted an announced pre-licensing inspection. LPA introduced self and was granted entry to the facility. LPA met with Administrator, I'isha Cooley. There are no residents present during this inspection. This facility is a 4 bedroom, 2 bathroom home.

This facility was originally going to be licensed as a new facility, however this facility is being licensed as a change of location due to a termination of the leasing agreement at the previous facility.

Per Administrator, all furnishings and food will be relocated to this location once the license has been obtained. LPA conducted a tour with Administrator. Facility appeared clean, hot water measured at 113.8 degrees F in bathroom 1 and 113.5 degrees F in bathroom 2. Smoke detector and carbon monoxide detector observed to be operational during today's inspection. Fire extinguisher was last serviced on 01/05/2023. Administrator stated sharps and medications will be kept in a mobile storage cabinet in the staff room. The mobile storage cabinet will be relocated to the facility once the license has been obtained. Chemicals /disinfectants will be kept in a locked file cabinet in the small room near the kitchen. The file cabinet will be relocated to this facility once the license has been obtained.

Outside of facility toured. Exits were open and free of obstructions.

LPA will submit documentation to CAB in Sacramento for final review prior to license being issued.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 07/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2023
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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