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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208802
Report Date: 09/30/2021
Date Signed: 10/04/2021 12:18:59 PM

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:OPEN ARMS HOUSE, THEFACILITY NUMBER:
547208802
ADMINISTRATOR:JIMENEZ, SABRINAFACILITY TYPE:
740
ADDRESS:3234 W IRIS AVETELEPHONE:
(559) 713-6542
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY:6CENSUS: 0DATE:
09/30/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Administrator, Sabrina JimenezTIME COMPLETED:
09:15 AM
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On 09/30/2021, Licensing Program Analyst (LPA) M.Yang arrived unannounced to conduct a Case Management visit and met with Administrator, Sabrina Jimenez. The purpose of this visit was to conduct a final walk through. Licensee has surrendered license. No staff and residents present.

LPA toured the facility inside and outside. All bedrooms and bathrooms were empty of personal belongings. There was no indication of persons living in the facility.

Forfeiture to be sent. The facility will be closed effective 9/30/2021, pending Licensing Program Manager approval. RO to contact LTCO. Exit interview conducted with Licensee and a copy of the report provided via email.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 243-8080
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021
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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