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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247209073
Report Date: 12/18/2023
Date Signed: 12/18/2023 09:24:20 PM


Document Has Been Signed on 12/18/2023 09:24 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
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:MARIA LOVING CAREFACILITY NUMBER:
247209073
ADMINISTRATOR:PELAYO, CHRISTINA MFACILITY TYPE:
740
ADDRESS:1115 PAYNE AVENUETELEPHONE:
(209) 733-8136
CITY:GUSTINESTATE: CAZIP CODE:
95322
CAPACITY:6CENSUS: DATE:
12/18/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:40 PM
MET WITH:TIME COMPLETED:
04:00 PM
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On 12/18/23 Licensing Program Analyst (LPA) B. Miranda arrived to the facility unannounced to conduct an unannounced case management visit. The Dept received documents requesting the facility to be closed as 12/1/2023.

There was no answer at the facility. From the outside LPA did not observe anyone in the facility. LPA attempted to call, but the mailbox was full and LPA was unable to leave a voicemail.

LPA will attempt to make contact and conduct another unannounced visit.

Report was not signed by staff since no contact was made.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brianna MirandaTELEPHONE: 559-770-0254
LICENSING EVALUATOR SIGNATURE:
DATE: 12/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/18/2023
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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