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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547201564
Report Date: 10/07/2022
Date Signed: 10/07/2022 11:14:47 AM


Document Has Been Signed on 10/07/2022 11:14 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:LOVING CARE ASSISTED LIVINGFACILITY NUMBER:
547201564
ADMINISTRATOR:PERRY, FEFACILITY TYPE:
740
ADDRESS:1542 E. GLENWOOD AVENUETELEPHONE:
(559) 688-4835
CITY:TULARESTATE: CAZIP CODE:
93274
CAPACITY:6CENSUS: 4DATE:
10/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Ronald Perry, LicenseeTIME COMPLETED:
11:25 AM
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Licensing Program Analyst (LPA) Lady Cabrera arrived at the facility unannounced to to drop off Resident's (R1) facility file to Licensee.

Exit interview conducted and a copy of this report was provided to Licensee.

SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Lady CabreraTELEPHONE: (559) 513-9832
LICENSING EVALUATOR SIGNATURE:
DATE: 10/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/07/2022
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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