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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 167204056
Report Date: 01/31/2024
Date Signed: 01/31/2024 04:12:27 PM

Document Has Been Signed on 01/31/2024 04:12 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:LEMOORE ADULT DAYFACILITY NUMBER:
167204056
ADMINISTRATOR:WARTSON, BOBBIEFACILITY TYPE:
775
ADDRESS:1075 BLAKE STREETTELEPHONE:
(559) 924-4419
CITY:LEMOORESTATE: CAZIP CODE:
93245
CAPACITY: 15CENSUS: 10DATE:
01/31/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Program Director (PD) Pam ChinTIME COMPLETED:
04:15 PM
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An unannounced Annual visit was conducted on the date & times indicated above by Licensing Program Analyst (LPA) K. McClurg. LPA met with Program Director (PD) Pam Chin. LPA introduced self, stated purpose of visit & was allowed to proceed with visit.

Physical plant toured. Program in single room. Room sufficiently furnished with adequate lighting. Bathroom, kitchen/food storage area & activity room observed to appear clean with no unpleasant odors. Program has outside area. Smoke detectors operational. Hot water available. Interior & exterior passageways clear of obstructions.

Records review to be conducted at a later date.

Exit interview conducted with PD. Report reported.


SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2024
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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