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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208243
Report Date: 09/04/2024
Date Signed: 09/04/2024 12:21:47 PM

Document Has Been Signed on 09/04/2024 12:21 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/
DIRECTOR:		HERNANDEZ, JAVIERFACILITY TYPE:
735
ADDRESS:10650 ROAD 256TELEPHONE:
(559) 527-5091
CITY:TERRA BELLASTATE: CAZIP CODE:
93270
CAPACITY: 100CENSUS: 11DATE:
09/04/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:08 AM
MET WITH:Carlos Bishop TIME VISIT/
INSPECTION COMPLETED:
12:35 PM
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On 9/06/24, Licensing Program Analysts (LPAs) M.Medina and A. Walton arrived unannounced to conduct a Case Management Annual Continuation visit. LPAs arrived, introduced self, and stated purpose of visit. LPAs allowed entrance by direct care staff. LPAs met with Carlos Bishop, Medication Services Manager to conduct visit.

LPAs conducted subsequent facility tour and completed inspection tool during visit.

LPAs requested the following documents during Annual Continuation visit to be submitted to Fresno Regional office no later 9/13/24: LIC 308 (Designation of Facility Responsibility), LIC 500 (Personnel Report), and LIC 9020 (Register of Facility Clients/Residents).

Exit interview conducted.

No deficiencies cited.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/04/2024
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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