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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208783
Report Date: 05/24/2022
Date Signed: 05/24/2022 12:34:09 PM

Document Has Been Signed on 05/24/2022 12:34 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:FRONTIER IN THE WESTFACILITY NUMBER:
547208783
ADMINISTRATOR:JENNIFER DOHNERFACILITY TYPE:
737
ADDRESS:32083 MANOTA CTTELEPHONE:
(559) 735-9564
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY: 4CENSUS: 3DATE:
05/24/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Administator Daniel Flores-LopezTIME COMPLETED:
12:45 PM
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Licensing Program Analyst LPA conducted a Case Management to follow up on an death report on 4/5/22. LPA met with Administrator Daniel Flores-Lopez and discussed the purpose of the visit.

Facility will email C1's file to LPA. LPA interviewed Administrator.


An exit interview was conducted with the Administrator a copy of this report was provided.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2022
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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