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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208864
Report Date: 10/11/2023
Date Signed: 10/11/2023 07:21:51 PM

Document Has Been Signed on 10/11/2023 07:21 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:HONOR IN THE WESTFACILITY NUMBER:
547208864
ADMINISTRATOR:PEREZ, MARIA M.FACILITY TYPE:
737
ADDRESS:13531 PERRY DRIVETELEPHONE:
(559) 713-1362
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY: 4CENSUS: 3DATE:
10/11/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Administrator (Admin) Maria Perez & Direct Service Provider (DSP) Gwena KaneTIME COMPLETED:
06:30 PM
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An unannounced Annual visit was conducted on the date & times indicated above by Licensing Program Analyst (LPA) K. Mcclurg. LPA met with Administrator (Admin) Maria Perez & Direct Service Professional (DSP) Gwena Kane.

This is an Adult Residential Enhanced Behavioral Supports Home. Facility has specific protocols regarding staff & visitors. Additional safety protocols & checklists in place prior to going onto floor in residential portion of facility.

Physical plant toured. 2 day supply of perishable & 7 day supply of Non perishable food on the premises. Dining & living rooms have required seating & lighting. Client bedrooms toured. Bedrooms have required furnishings & lighting. Bathroom used by client(s) toured. Bathroom appeared to be clean with no unpleasant odors. Locked storage observed for cleaning products & other hazardous items making them inaccessible to clients. Hot water tested & measured @ 115 degrees F.
Interior & exterior passageways observed to be clear with no obstructions.

Facility appeared to be clean with no unpleasant odors. Medications observed to be locked & to be organized. Smoke detectors operational. Fire Extinguisher service date: 12/3/2022.

Client & staff records to be reviewed at a future date.

Exit interview held with Admin. Report provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2023
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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