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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208793
Report Date: 09/09/2024
Date Signed: 09/09/2024 01:20:09 PM

Document Has Been Signed on 09/09/2024 01:20 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:BAXTER-LEYVA ADULT FACILITY, LLCFACILITY NUMBER:
547208793
ADMINISTRATOR/
DIRECTOR:		LEYVA, KRISTYNFACILITY TYPE:
735
ADDRESS:711 SANDRA LANETELEPHONE:
(559) 615-1697
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY: 6CENSUS: 4DATE:
09/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Kristyn LeyvaTIME VISIT/
INSPECTION COMPLETED:
02:01 PM
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Today, Licensing Program Analyst L. Xiong arrived at the facility unannounced to conduct the Annual Inspection. LPA met with Administrator Kristyn Leyva and inform her the purpose of the visit.

Administrator Kristyn Leyva brought facility records for review and provided the 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.

Smoke detector and carbon monoxide detectors observed operational during inspection. Fire extinguisher present with a service date of 1/2024. Water temperature observed to measure at 107 degrees F.

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