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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547203489
Report Date: 03/18/2022
Date Signed: 03/18/2022 04:14:57 PM

Document Has Been Signed on 03/18/2022 04:14 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:AGUILAR HOMEFACILITY NUMBER:
547203489
ADMINISTRATOR:AGUILAR, SYLVIA R.FACILITY TYPE:
735
ADDRESS:17353 ROAD 320TELEPHONE:
(559) 784-5157
CITY:SPRINGVILLESTATE: CAZIP CODE:
93265
CAPACITY: 4CENSUS: 3DATE:
03/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Administrator/Licensee Sylvia Aguilar; Licensee John Aguilar;TIME COMPLETED:
04:30 PM
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An Annual visit was conducted on the date & times indicated above by Licensing Program Analyst (LPA) K. Mcclurg. LPA met with Administrator/Licensee (A/L) Sylvia Aguilar & Licensee (L) John Aguilar LPA stated purpose of visit.

One central entry point has been designated for universal entry screening. Routine symptom screening including temperature taken & recorded daily for all staff, residents, & visitors.
Infection Control signs are posted, including in bathrooms with hand washing techniques. Soap & paper towels available. Face coverings in use & available. Sufficient supply of PPEs. Infection control policies & procedures & practices in place.

Exit interview conducted with A/L & L. Report Provided.
SUPERVISORS NAME: Andy Xiong
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2022
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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