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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 167208258
Report Date: 09/24/2021
Date Signed: 09/24/2021 08:50:34 AM

Document Has Been Signed on 09/24/2021 08:50 AM - 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:LINDSEY B/C HOMEFACILITY NUMBER:
167208258
ADMINISTRATOR:LINDSEY, SHEILA COXFACILITY TYPE:
735
ADDRESS:9573 HOME AVETELEPHONE:
(559) 582-6579
CITY:HANFORDSTATE: CAZIP CODE:
93230
CAPACITY: 5CENSUS: 5DATE:
09/24/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Sheila Lindsey, LicenseeTIME COMPLETED:
09:00 AM
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On 09/24/2021, Licensing Program Analysts (LPAs) M.Yang and S. Doucette arrived unannounced and attempted to conduct an Infection Control-Annual Inspection. LPAs met with Licensee Sheila Lindsey. Licensee states she "has to take residents to their appointment." Licensee not able to meet with LPAs for the annual inspection. The department will return at a later date to conduct Annual Inspection. A copy of report submitted via email to administrator.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 09/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/24/2021
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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