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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208243
Report Date: 07/12/2023
Date Signed: 07/12/2023 03:24:13 PM

Document Has Been Signed on 07/12/2023 03:24 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:ENCLAVE AT THE FOOTHILLSFACILITY NUMBER:
547208243
ADMINISTRATOR:HERNANDEZ, JAVIERFACILITY TYPE:
735
ADDRESS:10650 ROAD 256TELEPHONE:
(559) 527-5091
CITY:TERRA BELLASTATE: CAZIP CODE:
93270
CAPACITY: 100CENSUS: 15DATE:
07/12/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Javier HernandezTIME COMPLETED:
03:30 PM
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On 7/12/23, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Case Management visit regarding a self reported incident that occurred on 7/11/23. LPA Medina met with Administrator and stated purpose of visit.

Facility toured with Administrator and information gathered. LPA may conduct follow up visit at a later date if needed.

No deficiencies cited during today's visit.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2023
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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