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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 540404321
Report Date: 01/04/2021
Date Signed: 01/04/2021 04:06:19 PM

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 GRANDE ASSISTED LIVINGFACILITY NUMBER:
540404321
ADMINISTRATOR:SILVEIRA, J & MFACILITY TYPE:
740
ADDRESS:347 EAST WALNUTTELEPHONE:
(559) 733-0233
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY:49CENSUS: 0DATE:
01/04/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
03:18 PM
MET WITH:Lisa SilveiraTIME COMPLETED:
03:34 PM
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On this date, Licensing Program Analyst (LPA) M. Medina conducted a FaceTime video tour with Lisa Silveira.

LPA Medina informed at time of visit that there have been no clients in care since October 2020, all clients have been relocated to Casa Grande Senior Care Home #2, License #540405657.

Facility toured, all client bedrooms are vacant and LPA observed no personal belongings of clients in facility.

License and closing letter were received in Fresno Regional Office on 1/04/21. This facility closure is licensee initiated.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2021
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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