<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547206667
Report Date: 08/17/2022
Date Signed: 08/18/2022 02:42:13 PM

Document Has Been Signed on 08/18/2022 02:42 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:PEOPLE'S CARE BLISS CENTER VISALIAFACILITY NUMBER:
547206667
ADMINISTRATOR:DURAN, MELISSAFACILITY TYPE:
775
ADDRESS:909 W MURRAY RDTELEPHONE:
(559) 419-5415
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY: 60CENSUS: DATE:
08/17/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:47 PM
MET WITH:Administrator Billie Jean SmithTIME COMPLETED:
04:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst LPA Shawna Doucette responded to the facility to deliver PPE. LPA met with Administrator Billie Jean Smith. LPA delivered hand sanitzer, covid test kits, gloves, and N95 masks.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 08/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/17/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1