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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209336
Report Date: 09/26/2023
Date Signed: 09/26/2023 12:48:21 PM

Document Has Been Signed on 09/26/2023 12:48 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:CASA CANALES RESIDENTIALFACILITY NUMBER:
107209336
ADMINISTRATOR:CANALES, ARMANDOFACILITY TYPE:
735
ADDRESS:2785 N. DANTE AVE.TELEPHONE:
(805) 268-0834
CITY:FRESNOSTATE: CAZIP CODE:
93722
CAPACITY: 4CENSUS: 0DATE:
09/26/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Armando CanalesTIME COMPLETED:
01:15 PM
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Licensing Program Analysts (LPAs) Katie Brown and Lissett Padgett arrived at the facility to conduct the Pre-Licensing Inspection. LPA met with Administrator (AD) Armando Canales and Sylvia Arellano.

LPA began the tour by entering through the front door of the 5 bedroom/2 bathroom/1 story home. Sanitizer and visitor sign in located at entrance. Common areas have adequate furnishings and lighting. All 4 client bedrooms
have the required furnishings, bed linens, proper lighting and smoke detectors. Smoke and Carbon Monoxide detectors observed and in working order. LPAs observed a supply of extra bed linens, towels, and personal hygiene and grooming products. Hot water temperature in bathroom measured at 115 degrees F. Non-Skid mats are available, soap, paper towels and hand washing sign present along with storage available for client personal items.

Kitchen observed to have supply of dishes, plates, utensils, pots and pans. Food storage and preparation areas are clear and appropriate for food preparation. Cleaning supplies and chemicals are locked in the hallway closet and sharps/knives in a lock box in the kitchen. Appliances observed to be in working order. LPAs observed a 7 day of non-perishable food stored in a pantry with additional in the garage. Medications will be stored and locked in the staff room in a locking cabinet. First aid kit contains all the required items. A fire extinguisher is present and was certified 4/14/23. Washer and Dryer observed in the laundry room with additional storage space available. Door and passageways are unobstructed throughout the home. Outside of the facility toured. There is a covered seating area and a self-releasing gate found to be working properly. The home does not have a pool.

See Lic.809-C for continuation of report
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Katie Brown
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: CASA CANALES RESIDENTIAL
FACILITY NUMBER: 107209336
VISIT DATE: 09/26/2023
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Component III was conducted during pre-licensing visit with AD.

LPAs called the designated facility phone (559) 375-1448 during the visit. The phone is set up and in working
order.

The applicant has met all pre-licensing requirements. LPAs will submit documentation to CAB in Sacramento
for final review prior to license being issued.

An exit interview was conducted and a copy of this report was left with AD, whose signature confirms receipt of these documents.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Katie Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
LIC809 (FAS) - (06/04)
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