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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208825
Report Date: 02/12/2024
Date Signed: 02/12/2024 02:26:31 PM

Document Has Been Signed on 02/12/2024 02:26 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:PEOPLE'S CARE DAMSENFACILITY NUMBER:
547208825
ADMINISTRATOR:GAMEZ-PLACENCIA, YADIRAFACILITY TYPE:
735
ADDRESS:6502 W DAMSEN AVETELEPHONE:
(559) 627-1281
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY: 4CENSUS: 3DATE:
02/12/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:28 PM
MET WITH:Administrator, Yadira Gamez-Placencia and District Manager, Jose MarquezTIME COMPLETED:
02:38 PM
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On 02/12/2024, Licensing Program Analysts (LPAs) Walton and Salazar arrived unannounced to conduct a POC inspection. LPAs introduced themselves, stated the purpose of the visit and requested to meet with the Administrator. LPAs met with Administrator, Yadira Gamez-Placencia and District Manager, Jose Marquez.

The purpose of today's visit was to follow up on a deficiency issued during the annual inspection on 01/13/2024. During the annual inspection, licensee agreed to purchase a new mattress for a resident in care.

During today's visit, LPAs observed the same bedroom furniture in the resident's bedroom. Interviews with the Administrator and District Manager revealed that a new mattress and a new bedframe have been purchased and will be placed in the resident's room by 02/16/2024. LPAs agreed to extend the POC due date until 02/16/2024.

No deficiencies issued. Exit interview conducted and a copy of this report was discussed and provided to Administrator, Yadira Gamez-Placencia, whose signature on this form confirms receipt of this document.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 02/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/12/2024
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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