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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 150406808
Report Date: 06/26/2023
Date Signed: 06/26/2023 02:02:38 PM

Document Has Been Signed on 06/26/2023 02:02 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:DAI BREAKFACILITY NUMBER:
150406808
ADMINISTRATOR:CORNELL, BEVERLYFACILITY TYPE:
775
ADDRESS:14150 1/2 SUNSET BLVD.TELEPHONE:
(661) 854-4543
CITY:ARVINSTATE: CAZIP CODE:
93203
CAPACITY: 40CENSUS: 35DATE:
06/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:02 AM
MET WITH:Christie WilliamsTIME COMPLETED:
01:45 PM
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On 6/26/23, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Required Annual inspection and met with Christie Williams, Chief Financial Officer and Emily Williams, Residential Coordinator to conduct facility tour.

Currently there are 35 Clients in placement. Day Program hours are Monday - Friday 8:30 am to 1:30 pm.

Facility buildings and grounds toured during inspection. Dai Break does not cook meals on site but does not provide meals, but the facility has a kitchen area for storing and heating clients lunches.

Resident bathrooms appeared clean & fixtures are operational. LPA observed cleaning supplies and hazardous chemicals are stored in a locked cabinet in the staff bathroom and observed to be inaccessible to clients.

Fire extinguishers were present throughout the facility with 9/05/22. Fire drills are conducted quarterly, the last fire drill was conducted on May 2023 according to facility records.

No deficiencies observed during inspection. A copy of report provided to Chief Financial Officer for facility records.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 06/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/26/2023
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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