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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208825
Report Date: 12/19/2023
Date Signed: 12/19/2023 12:57:56 PM

Document Has Been Signed on 12/19/2023 12:57 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:ALLEN, TARAFACILITY TYPE:
735
ADDRESS:6502 W DAMSEN AVETELEPHONE:
(559) 627-1281
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY: 4CENSUS: 3DATE:
12/19/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
12:27 PM
MET WITH:Administrator, Tara AllenTIME COMPLETED:
01:10 PM
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On 12/19/2023, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct a case management - health checks inspection. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with Administrator, Tara Allen.

There are no residents present during today's inspection. LPA conducted a tour of the facility. There are no fire clearance issues during today's inspection. All passageways are clear from obstructions. LPA observed an adequate food supply.

LPA is requesting the following documents for R1 be submitted to the Fresno CCL office by 5:00 PM on 12/20/2023: Emergency contact information, admission agreement, IPP and the physician's report. LPA is also requesting the staff schedule from November - December 2023, personnel roster, and staff contact information.

No deficiencies issued during today's inspection.

Exit interview conducted. A copy of this report was discussed and provided to Administrator, Tara Allen, whose signature on this form confirms receipt for this document.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2023
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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