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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202056
Report Date: 10/16/2024
Date Signed: 10/16/2024 03:28:22 PM

Document Has Been Signed on 10/16/2024 03:28 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:CIELO VISTAFACILITY NUMBER:
275202056
ADMINISTRATOR/
DIRECTOR:		MARK CASTILLOFACILITY TYPE:
735
ADDRESS:806 ELM AVENUETELEPHONE:
(831) 674-2180
CITY:GREENFIELDSTATE: CAZIP CODE:
93927
CAPACITY: 40CENSUS: 40DATE:
10/16/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:50 PM
MET WITH:Assistant Administrator - Monique BalladaresTIME VISIT/
INSPECTION COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) M Vega arrived unannounced to conduct a Case Management visit on 10/16/2024 at 02:55 p.m.. LPA met with facility Erica Zapeda, and stated the purpose of the visit. Erica obtained contact with Assistant Administrator Monique Balladares. Stated the purpose of visit to Assistant Administrator.

LPA served Decision and Order excluding Staff 1 (S1) from being present inside the facility. LPA requested a current and updated Personnel Report (LIC 500) and Guardian account be updated to remove S1 from the facility staff roster. A notice of completion shall be submitted to Community Care Licensing (CCL).

LPA informed Assistant Administrator Monique Balladares that S1 is not allowed to be employed and/or on any facility premises. The Decision and Order of Exclusion From All Facilities came into effect as of 07/09/2024 upon receipt of the letter. A copy of the letter was given to facility Assistant Administrator Monique Balladares during this visit.

Per California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies were observed and cited. Exit interview held with Assistant Administrator Monique Balladares, A Copy of report given.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Martin Vega
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2024
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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