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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547206666
Report Date: 08/22/2024
Date Signed: 08/23/2024 01:38:13 AM

Document Has Been Signed on 08/23/2024 01:38 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:KAISER SPECIALIZED RESIDENTIAL VASSARFACILITY NUMBER:
547206666
ADMINISTRATOR/
DIRECTOR:		PUGA-ORTEGA, RICARDOFACILITY TYPE:
735
ADDRESS:4224 E VASSAR AVETELEPHONE:
(559) 622-8955
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY: 4CENSUS: 4DATE:
08/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
05:30 PM
MET WITH:Administrator (Admin) Ricardo Puga OrtegaTIME VISIT/
INSPECTION COMPLETED:
07:00 PM
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An Annual visit was conducted by Licensing Program Analyst (LPA) K. McClurg. LPA met with Administrator (Admin) Ricardo Puga Ortega. LPA introduced self, provided business card, stated purpose of visit, & was allowed to proceed.

Physical plant toured. Dining & living rooms sufficiently furnished with adequate lighting. Kitchen appeared to be clean & maintained appropriately. Sufficient food. Freezer/Refrigerator appeared to be clean & sufficiently maintained to allow food to be kept at appropriate temperatures. Resident bedrooms toured. Bedrooms sufficiently furnished with adequate lighting. Sufficient amount of linens available. Resident bathrooms appeared to be clean with no unpleasant odors. Fixtures operational. Hot water measured @ 109 degrees F.

Entries & hallways observe to be clear & free of obstruction. No hazards observed in backyard areas. Medications organized & locked. Client & staff files appropriately maintained. Smoke & Carbon Monoxide detectors operational. Fire extinguisher service date: 11/28/23.

Exit interview conducted with Admin. Report provided.

SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2024
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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