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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547206748
Report Date: 12/14/2023
Date Signed: 12/14/2023 07:35:35 PM

Document Has Been Signed on 12/14/2023 07:35 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:SANDOVAL HOME IIIFACILITY NUMBER:
547206748
ADMINISTRATOR:SANDOVAL, CHRISTINEFACILITY TYPE:
735
ADDRESS:13851 AVENUE 320TELEPHONE:
(559) 636-7688
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY: 6CENSUS: 4DATE:
12/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
05:30 PM
MET WITH:Licensee/Administrator (L/A) - Christine SandovalTIME COMPLETED:
06:30 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
An Annual Inspection Control visit was conducted on the date & times indicated above by LPA K. Mcclurg. LPA met with Licensee/Administrator (L/A) Christine Sandoval. LPA reviewed the purpose of the visit with L/A.

Facility toured. Kitchen appeared to be clean & organized. Knives locked in drawer. 7 days Non-Perishable & 2 days Perishable food on the premises. Dining/living room sufficiently furnished & furnishings appeared to be in good repair. Resident rooms toured. Rooms sufficiently furnished & furnishings appeared to be in good repair.

Resident bathrooms appeared & smelled to be clean with no unpleasant odors. Fixtures operational. Hot water measured at 114 degrees F. All interior & exterior passageways clear with no obstructions, including exit doors of each resident bedroom. Smoke & carbon dioxide detectors tested operational. Outside area toured. Sufficient seating in good repair observed.


Exit interview conducted with L/A. Report provided @ time of visit.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE: DATE: 12/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2023
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