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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209045
Report Date: 12/22/2022
Date Signed: 05/02/2023 02:07:02 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 05/02/2023 02:07 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:SVS DELANOFACILITY NUMBER:
157209045
ADMINISTRATOR:COPELAND, SUZANNEFACILITY TYPE:
775
ADDRESS:1323 MAIN ST.TELEPHONE:
(559) 443-7119
CITY:DELANOSTATE: CAZIP CODE:
93215
CAPACITY: 30CENSUS: 14DATE:
12/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Samuel Pedroza, Program DirectorTIME COMPLETED:
02:00 PM
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On 12/22/22, Licensing Program Analyst (LPA)L. Salazar arrived at the facility unannounced to conduct an Infection Control/Annual Inspection. LPA met with Program Director, Samuel Pedroza . LPA stated the purpose of the visit and was allowed entry into the facility. LPA entered through a central entry point and did not observed a screening sign-sheet and PPE precautionary measures in place. LPA was not COVID pre-screened at entry.

Program Director completed tour of facility with LPA. Clients left for the day during time of visit. Furniture in common areas/activity rooms are spaced to promote physical distancing. A supply of PPE is located in the supply closet. Medications not provided during program. Hand washing postings were observed at hand washing stations.

Exit Interview conducted. The following documents are requested and to be submitted to Fresno CCL by: 01/4/23. The following updated forms were requested: LIC 308, LIC 309 (if applicable), LIC 500, LIC 610D, LIC 9020, and current Administrator certificate with qualifications.

No deficiencies cited during todays visit. Exit interview completed with Program Director, Samuel Pedroza. A copy of this report was given.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/22/2022
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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