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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547203489
Report Date: 02/23/2024
Date Signed: 02/23/2024 12:14:29 PM

Document Has Been Signed on 02/23/2024 12:14 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: 1DATE:
02/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:44 AM
MET WITH:John Aguilar
Sylvia Aguilar		TIME COMPLETED:
12:10 PM
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On 2/23/2024, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required Inspection. LPA arrived, introduced self, and stated purpose of visit. LPA allowed entrance by Licensee, John Aguilar. Also present, Sylvia Aguilar, Administrator Certificate #6006559735, expires 8/5/2025.

Facility, currently has resident in placement. Resident was present during today's inspection. Facility tour conducted. Facility observed to be clean, and a comfortable temperature. Resident rooms are full furnished with all required furnishings. Bathroom toured, water temperature measured at 112 degrees F. All common areas have adequate seating and lighting for residents in care. Kitchen toured, all knives were observed to be locked and secured in kitchen drawer. Facility has a 2-day supply of perishable food and a 7-day supply of non-perishable food available. All cleaning supplies are locked and secured in laundry room, and garage.


Facility is equipped with a pull station. Fire extinguisher present with a service date of 4/25/2023. Last fire drill conducted 2/03/2024. Last fire drill conducted 2/03/2024 according to facility records. Smoke detectors and carbon monoxide present and observed operational during today's inspection.

Outside of facility is surrounded by perimeter gate. No hazards observed.

Licensee to submit copy of Administrator's certificate to Fresno CCL.

No deficiencies observed during inspection. Copy of report provided and time of visit for facility records.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2024
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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