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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 167202434
Report Date: 03/11/2022
Date Signed: 03/18/2022 05:42:43 PM

Document Has Been Signed on 03/18/2022 05:42 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 DEL RIOFACILITY NUMBER:
167202434
ADMINISTRATOR:MARMON, JILLFACILITY TYPE:
735
ADDRESS:817 W SEVENTH STTELEPHONE:
(559) 380-2170
CITY:HANFORDSTATE: CAZIP CODE:
93230
CAPACITY: 14CENSUS: 11DATE:
03/11/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator Jill Marmon TIME COMPLETED:
11:30 AM
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On this date, LPA K. Kaur conducted a case management inspection to the facility to follow up on an incident report and SOC 341 that was self reported by the facility regarding a staff having an inappropriate relationship with a resident. The SOC 341 was cross reported to local PD, CCL, and Ombudsman by the facility. LPA met with Administrator Jill Marmon and stated the purpose of the visit.

During the inspection, LPA interviewed resident and Administrator.

LPA also obtained copies of the staff and resident’s file. A copy of the facility’s internal investigation was also obtained.

This incident may require further follow-up and LPA will return at a later if required.

Exit Interview was conducted.
SUPERVISORS NAME: Brenda White
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2022
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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