<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547202724
Report Date: 09/25/2023
Date Signed: 09/25/2023 01:18:44 PM

Document Has Been Signed on 09/25/2023 01:18 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:SUCCESS IN RECOVERY IIFACILITY NUMBER:
547202724
ADMINISTRATOR:SHAWNAA SUPNETFACILITY TYPE:
733
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 6CENSUS: 5DATE:
09/25/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Elizabeth ReynagaTIME COMPLETED:
01:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On September 25, 2023, Licensing Program Analyst (LPA) Vanessa Galvan traveled to Success in Recovery located in Visalia, California to conduct an unannounced visit and met with Elizabeth Reynaga, Assistant Program Director. The purpose of the visit was to continue the Required/Random inspection that was started on 9/22/2023.

LPA reviewed 5 staff files, Emergency Intervention Plan, and Board Meeting meeting Minutes.

LPA discussed training requirements for facility managers, access to a Nurse, and reporting Incidents in the requirement time frame. LPA Galvan will provide Elizabeth with information regarding regulatory standards.

The will be two technical violations issued on today's visit. A copy of this report was provided to Elizabeth Reynaga at the conclusion of this inspection.

SUPERVISORS NAME: Lourey Bartolome
LICENSING EVALUATOR NAME: Vanessa Galvan
LICENSING EVALUATOR SIGNATURE: DATE: 09/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/25/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3