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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547203298
Report Date: 06/14/2024
Date Signed: 06/14/2024 02:28:18 PM


Document Has Been Signed on 06/14/2024 02:28 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:AUTUMN OAKSFACILITY NUMBER:
547203298
ADMINISTRATOR:ONG, ANTONIO G.FACILITY TYPE:
740
ADDRESS:848 N. JAYE STREETTELEPHONE:
(559) 784-4144
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY:44CENSUS: DATE:
06/14/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
12:57 PM
MET WITH:Tony and Lisa OngTIME COMPLETED:
01:58 PM
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On or about today's date, an informal conference was conducted at the Fresno Adult/Senior Regional Office to discuss issues regarding food, finance and medications. Present during the meeting were licensee Lisa Ong, Administrator Tony Ong, staff Matilda Garcia, Licensing Program Manager Melinda Hoffmann and LPA Les Xiong. During the meeting TSP (Technical Support Program) was offered and accepted by the Licensee and Administrator.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Les XiongTELEPHONE: (559) 410-1772
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2024
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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