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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208243
Report Date: 12/08/2021
Date Signed: 12/08/2021 11:32:09 AM

Document Has Been Signed on 12/08/2021 11:32 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:ENCLAVE AT THE FOOTHILLSFACILITY NUMBER:
547208243
ADMINISTRATOR:PEREZ, KRISTINAFACILITY TYPE:
735
ADDRESS:10650 ROAD 256TELEPHONE:
(559) 527-5090
CITY:TERRA BELLASTATE: CAZIP CODE:
93270
CAPACITY: 20CENSUS: 0DATE:
12/08/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:23 AM
MET WITH:Staff Javier HernandezTIME COMPLETED:
11:30 AM
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On 12/8/2021, Licensing Program Analyst (LPA) Darius Williams, conducted an unannounced case management visit to follow up on an open complaint and pending audit. LPA met with staff Javier Hernandez and discussed the purpose of the visit.

The purpose of this visit is the Department is conducting a financial audit as a result of an open complaint where additional information was found regarding possible violations of personal rights. The Licensee and/or Licensee Representative for the facility is to provide to the Department all of the following listed documents by 12/30/2021:

· P&I Logs for all facilities January 2021 – Current (Due to the volume this request will only cover this year) – Should an exception be noted further documentation for the exception may be needed.


· All Wealth Wagon Cards sold for all facilities April 2020 – Current
· P&I ledgers for all clients who P&I is being held for, April 2020 - Current
· Status of where all P&I funds are kept – if in a financial institution – Bank statements for April 2020 – Current
· Cash handling policy and procedures (this may have been previously furnished, if not please provide)
· Copy of Bond for all facilities

This information is used for the purpose of auditing and regulating Community Care Facilities and Residential Care Facilities for the Elderly.

A copy of this report was provided to the Licensee Representative during this visit.

SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Darius Williams
LICENSING EVALUATOR SIGNATURE: DATE: 12/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/08/2021
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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