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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 540405657
Report Date: 02/06/2023
Date Signed: 02/07/2023 08:16:27 AM


Document Has Been Signed on 02/07/2023 08:16 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:CASA GRANDE SENIOR CARE HOME #2FACILITY NUMBER:
540405657
ADMINISTRATOR:SILVEIRA, JOE & MARIAFACILITY TYPE:
740
ADDRESS:417 E. WALNUT AVETELEPHONE:
(559) 733-0233
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY:46CENSUS: 0DATE:
02/06/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:52 PM
MET WITH:Administrator Lisa SilveiraTIME COMPLETED:
03:30 PM
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On 02/06/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct a Case Management visit and met with Administrator Lisa Silveira. The department received notification from the Administrator of facility closing. The purpose of this visit was to conduct a final walk through of the facility. Licensee has surrendered license. No staff and clients present.

LPA toured the facility inside and outside. All bedrooms and bathrooms were empty of personal belongings. There was no indication of persons living in the facility. Licensee provided LPA information of residents relocation.

Forfeiture to be sent. The facility will be closed effective 02/06/23, pending Licensing Program Manager approval. Exit interview conducted. Administrator was provided a copy of this report.

SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:
DATE: 02/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/06/2023
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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