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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547204082
Report Date: 08/31/2021
Date Signed: 08/31/2021 02:30:59 PM

Document Has Been Signed on 08/31/2021 02:30 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:ABARQUEZ HOMES INC.FACILITY NUMBER:
547204082
ADMINISTRATOR:ANDRES, RICARDOFACILITY TYPE:
735
ADDRESS:312 NW 4TH STREETTELEPHONE:
(559) 741-1296
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY: 4CENSUS: DATE:
08/31/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
07:30 AM
MET WITH:Adminsitrator Ricardo AndresTIME COMPLETED:
08:00 AM
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Licensing Program Analyst (LPA) Shawna Doucette contacted the facility to commence a case management. LPA Shawna Doucette did not make entry into the facility due to COVID-19 and pre-cautionary measures.

LPA Shawna Doucette left the Administrator with 2 packages of gowns and 1 box of N95 masks.


Signature was not obtained due to Covid 19 pre-cautionary measures.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2021
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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