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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208883
Report Date: 02/13/2024
Date Signed: 02/15/2024 06:38:31 AM

Document Has Been Signed on 02/15/2024 06:38 AM - 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 AVENUE 344FACILITY NUMBER:
547208883
ADMINISTRATOR:ENNIS, KRISTINFACILITY TYPE:
738
ADDRESS:14453 AVENUE 344TELEPHONE:
(559) 798-1655
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY: 4CENSUS: 4DATE:
02/13/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Kristin Ennis, Administrator
Jose Marquez, Distrcit Manager 		TIME COMPLETED:
07:29 PM
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On 02/13/24 Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to conduct the required annual visit. LPA was greeted by the Administrator and was allowed entry into the facility. District Manager arrived shortly after.

LPA toured the facility inside and out with Administrator and District Manager. LPA observed 4 out of 4 residents in care at the time of visit. There were 7 staff members present at the time of visit.

LPA requested Personnel Report (LIC500) and current staff training for all personnel listed on LIC500. LPA also requested IPP's, Functional Behavior Assessments and LIC 602 (Physician's Report) for all resident's in care to be sent to LPA by 02/16/24.

Due to the capacity at the home during the time of visit, LPA will complete the annual report off-site, and return at a later date. No immediate Health & Safety concerns were observed at the time of visit. No deficiencies cited.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2024
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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