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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157200175
Report Date: 07/17/2024
Date Signed: 07/19/2024 01:13:55 PM

Document Has Been Signed on 07/19/2024 01:13 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:ACESFACILITY NUMBER:
157200175
ADMINISTRATOR/
DIRECTOR:		IRVING, CONNIEFACILITY TYPE:
775
ADDRESS:612 MAIN STREETTELEPHONE:
(661) 721-3220
CITY:DELANOSTATE: CAZIP CODE:
93215
CAPACITY: 90CENSUS: 30DATE:
07/17/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Connie Irving, Program DirectorTIME VISIT/
INSPECTION COMPLETED:
04:19 PM
NARRATIVE
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On 7/17/24, Licensing Program Analysts (LPAs) M Medina and L. Salazar arrived to the Day Program unannounced to conduct a Case Management Annual Continuation visit.

LPAs purpose of visit was to review a sample of staff and client files.

Exit interview conducted. No deficiencies cited.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 07/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/17/2024
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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