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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208235
Report Date: 09/17/2024
Date Signed: 09/18/2024 04:02:11 PM

Document Has Been Signed on 09/18/2024 04:02 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:DE BOER HOME #3FACILITY NUMBER:
547208235
ADMINISTRATOR/
DIRECTOR:		DE BOER, BREANNFACILITY TYPE:
735
ADDRESS:2221 W. WHITE CHAPEL WAYTELEPHONE:
(559) 350-3695
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY: 4CENSUS: 4DATE:
09/17/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:26 PM
MET WITH:Shawna ThreadwellTIME VISIT/
INSPECTION COMPLETED:
05:42 PM
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Today, Licensing Program Analyst L. Xiong was at the facility conductin an unannounced Annual Inspection. LPA met with staff Walter Idolyantes and spoke to House Manager Shawna Treadwell on the phone and inform them the purpose of the visit.

Staff provided 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. Kitchen toured, LPA observed a 2-day supply of perishable and a 7-day supply of non-perishable food available for residents.

No deficiencies were observed.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Les Xiong
LICENSING EVALUATOR SIGNATURE: DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/18/2024
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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