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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547204112
Report Date: 08/15/2023
Date Signed: 08/16/2023 06:10:50 AM

Document Has Been Signed on 08/16/2023 06:10 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:SOCIAL VOCATIONAL SERVICES, VISALIA #2FACILITY NUMBER:
547204112
ADMINISTRATOR:THEADOSIA JOHNSONFACILITY TYPE:
775
ADDRESS:3140 WEST CALDWELL AVENUETELEPHONE:
(559) 735-0938
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY: 75CENSUS: 62DATE:
08/15/2023
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
11:46 AM
MET WITH:Theadosia Johnson, AdministratorTIME COMPLETED:
12:55 PM
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On 8/15/23 at 11:46 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct a collateral inspection. LPA explained reason for inspection and met with Theadosia Johnson.

LPA interviewed R1, made observations, and reviewed records.

No deficiencies cited during this inspection.

Exit interview conducted. A copy of this report was given to Administrator, whose signature confirms receipt of this report.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2023
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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