<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208883
Report Date: 02/15/2024
Date Signed: 02/21/2024 09:37:14 AM

Document Has Been Signed on 02/21/2024 09:37 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:
02/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:31 AM
MET WITH:Administrator, Kristen Ennia
District Manager, Jose Marquez 		TIME COMPLETED:
04:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 02/15/24, Licensing Program Analyst (LPA) L. Salazar arrived to the facility unannounced to conduct the required Annual Inspection Visit. LPA was greeted by Administrator, stated the purpose of the visit and was allowed entry into the facility. Administrator on record is Kristin Ennis # 6056767735 Expiration 07/23/24.

LPA conducted a tour of the facility, inside and out. Facility temperature was 69 degrees F. There were 2 residents in care at the time of visit, 2 residents were attending day program and arrived later. Facility is a 4 bedroom 3 bathroom home. Private resident bedrooms were observed to have the required lighting and furnishings and were free from odor and free from any passageway obstruction / fire hazards. LPA observed the required 7-day supply of non-perishable food and 2- day supply of fresh perishables to be properly stored. An emergency disaster supply was observed.

Bathrooms were toured and observed to have operational lights, running water, and non- slip floors. Hot water temperature tested at 111 degrees F. Trash can with lid and hand washing postings were observed. Internet devices and a working phone line were observed to be available for residents in care. A supply of extra linen's and towels were observed in the Hallway.

Carbon monoxide and smoke detectors were tested and observed to be operational. Carbon Monoxide detectors are located in the both common hallways and living room. A State Fire Marshall approved automatic fire sprinkler system was observed to be operational. Fire Extinguisher was observed with a service date of 02/09/24. The frame of the fire door inside the east hallway is bent. First aid kit was observed to be adequate.

Cleaning supplies were observed to be in a locked cabinet in the garage. The exterior tour of back yard was conducted and found to be free from debris. A covered outdoor seating area was observed for residents in care. This is a delayed egress home and gates were found to be operational. Quarterly Earthquake & Fire Drill logs were observed for staff 01/05/24. (Continued on 809-C)
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2024
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)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 344
FACILITY NUMBER: 547208883
VISIT DATE: 02/15/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
(Continued from 809)

LPA obtained Resident current medical assessment, Individual Performance Plans, Individual Behavioral Support Plans.

The following documents were obtained at the time if visit. LIC 500, LIC 9020, LIC 610D, Disaster Plan. LPA requested the following be submitted to Fresno CCL by: 03/01/24: LIC 308, LIC 400, LIC 402,

An exit interview was conducted and a copy of this report was discussed and provided to licensee. No deficiencies cited on today's visit. LPA will review and return at a later visit to complete records review.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2