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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208809
Report Date: 06/14/2021
Date Signed: 06/14/2021 02:18:34 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:PARK VISALIA ASSISTED LIVINGFACILITY NUMBER:
547208809
ADMINISTRATOR:RENEE HAMILTONFACILITY TYPE:
740
ADDRESS:3939 WEST WALNUT AVENUETELEPHONE:
(559) 625-3388
CITY:VISALIASTATE: CAZIP CODE:
93277
CAPACITY:110CENSUS: 55DATE:
06/14/2021
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Administrator, Renee HamiltonTIME COMPLETED:
01:10 PM
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On 06/14/2021, Licensing Program Analyst (LPA) A. Walton arrived unannounced to conduct a Health and Safety Inspection. LPA met with Administrator, Renee Hamilton. LPA introduced self and stated the purpose of the visit.

LPA conducted a tour of the facility with Administrator. No immediate Health and Safety concerns were observed. A copy of R1's entire facility file was provided to LPA.

No deficiencies issued during the inspection.

An exit interview was conducted. As a COVID-19 precautionary measure, a copy of this report was provided via email and an electronic read receipt confirms receiving this document. Facility Representative signature on file.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2021
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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