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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547206868
Report Date: 11/13/2024
Date Signed: 11/14/2024 09:20:27 AM

Document Has Been Signed on 11/14/2024 09:20 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:ANGIE EDWARDS RESIDENTIAL SERVICESFACILITY NUMBER:
547206868
ADMINISTRATOR/
DIRECTOR:		ANGIE R HUGLE EDWARDSFACILITY TYPE:
735
ADDRESS:2442 W. NANCYTELEPHONE:
(559) 788-1047
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY: 5CENSUS: 4DATE:
11/13/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:17 PM
MET WITH:Alex MontoyaTIME VISIT/
INSPECTION COMPLETED:
05:33 PM
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Today, Licensing Program Analyst L. Xiong arrived at the facility unannounced to conduct a Case Management visit pertaining to CDSS case no. 7924141004. LPA met staff Alex Montoya and spoke to Administrator Angie Edwards on the phone and inform them the purpose of the visit.

Staff A. Montoya provided the facility tour for LPA. Facility appeared clean with no obstruction or fire clearance issues. All common areas have adequate seating and lighting. Resident bedrooms toured, rooms observed to have all required accommodations. S1 was not present at the facility.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Les Xiong
LICENSING EVALUATOR SIGNATURE: DATE: 11/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/13/2024
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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