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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208883
Report Date: 09/23/2024
Date Signed: 09/24/2024 11:23:21 AM

Document Has Been Signed on 09/24/2024 11:23 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/
DIRECTOR:		CASTILLO, SABRINAFACILITY TYPE:
738
ADDRESS:14453 AVE 344TELEPHONE:
(559) 798-1655
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY: 4CENSUS: 4DATE:
09/23/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Operations Administrator (OpAdmin) Sonya Thomasson by telephone; Lead Staff; Registered Behavior Technician Norma AlmarazTIME VISIT/
INSPECTION COMPLETED:
06:00 PM
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A Case Management - Health & Safety visit was conducted by Licensing Program Analyst (LPA) K. McClurg. LPA spoke with Operations Administrator (OpAdmin) Sonya Thomasson. LPA stated purpose of visit & if available. LPA met with Lead Staff; Registered Behavior Technician Norma Almaraz LPA introduced self, stated purpose of visit, & was allowed to proceed with visit.

Purpose of visit to review incident as occurred on 9/5/2024 regarding Client 1. Reviewed client documents, including MARs & CSMDR. Incident discussed LS.

Exit interview conducted with LS. Report provided.

NOTE: Administrator status is to be reviewed & processed by the Department.
Once review complete, OpAdmin will be designated by the Department
as Administrator Of Record.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE: DATE: 09/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/23/2024
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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