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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208864
Report Date: 07/30/2024
Date Signed: 07/30/2024 06:55:50 PM

Document Has Been Signed on 07/30/2024 06:55 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/
DIRECTOR:		PEREZ, MARIA M.FACILITY TYPE:
737
ADDRESS:13531 PERRY DRIVETELEPHONE:
(559) 713-1362
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY: 4CENSUS: 4DATE:
07/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:45 PM
MET WITH:Administrator (Admin) Maria Perez; Program Liaison & Quality Assurance Development (PLAD) Antoinette MooreTIME VISIT/
INSPECTION COMPLETED:
07:00 PM
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An Annual visit was conducted on the date & times indicated above by Licensing Program Analyst (LPA) K. Mcclurg. LPM met with Administrator (Admin) Maria Perez &Program Liaison & Quality Assurance Development (PLAD) Antoinette Moore, greeted one another, stated purpose of visit, & was allowed to proceed with visit.

Physical plant observed. Sufficient furnishings with adequate lighting in living, dining, & resident rooms. Resident bathrooms have working fixtures. 2 day supply perishable & 7 day supply non-perishable food on premises. Hazardous items, including detergents, cleansers, etc. maintained in locked area inaccessible to clients & not stored with food.

Medications locked & organized. Medication paperwork appropriately maintained. MARs maintained. Client files reviewed. Staff files reviewed. Administrator Cert # 6063117735 exp 5/22/26. Complete 1st aid kit available.

This facility has an in-ground pool with 5 foot fence & locking gate was locked. Staff have water safety certificates. Operational smoke & carbon monoxide detectors. Fire extinguisher service date 12/22/23.

Exit interview conducted. Report provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE: DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/30/2024
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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