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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208877
Report Date: 04/15/2024
Date Signed: 04/17/2024 05:17:49 PM

Document Has Been Signed on 04/17/2024 05:17 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 CHAVEZFACILITY NUMBER:
547208877
ADMINISTRATOR/
DIRECTOR:		EMILY CARPENTERFACILITY TYPE:
735
ADDRESS:1228 CHAVEZ CTTELEPHONE:
(559) 688-4968
CITY:TULARESTATE: CAZIP CODE:
93274
CAPACITY: 4CENSUS: 4DATE:
04/15/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:53 PM
MET WITH:Emily Carpenter, Administrator TIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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On 04/15/24, Licensing Program Analyst (LPA) L.Salazar arrived at the facility unannounced to conduct an annual continuation. LPA was greeted by staff, stated the purpose of the visit and was allowed entry into the facility. Administrator was called and arrived shortly after.

LPA reviewed resident records and staff records and observed them to have the required documentation and training.

The following documents are requested and submitted to Fresno CCL by: 05/17/24: LIC 308, LIC 402, LIC 500, LIC 610D. An exit interview was conducted with Compliance Director. A copy of this report was discussed and provided at the time of visit. No deficiencies cited on today's visit.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 04/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/15/2024
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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