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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547208982
Report Date: 09/27/2022
Date Signed: 09/30/2022 07:05:30 PM

Document Has Been Signed on 09/30/2022 07:05 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:ANGIE EDWARDS RESIDENTIAL SERVICESFACILITY NUMBER:
547208982
ADMINISTRATOR:HUGLE-EDWARDS, ANGELAFACILITY TYPE:
735
ADDRESS:2423 W. WESTFIELD AVETELEPHONE:
(559) 784-6748
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY: 6CENSUS: 6DATE:
09/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:32 PM
MET WITH:Ryan EdwardsTIME COMPLETED:
02:48 PM
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On 9/27/22, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required Infection Control Inspection. LPA introduced self and allowed entrance by DSP staff, Licensee contacted by telephone and arrived a short time later to conduct inspection visit. All COVID-19 guidelines are in place. Visitor log-in/temperature check was observed upon entry. Facility has one entrance/exit point, all staff and visitors enter through front door. Facility staff observed to be wearing masks.

Facility appeared clean with no obstruction or fire clearance issues. All common areas have adequate seating and lighting. Resident bedrooms toured, rooms observed to have all required accommodations. Facility has 2 shared rooms with adequate spacing between beds, and 2 private bedrooms. Kitchen toured, LPA observed a 2-day supply of perishable and a 7-day supply of non-perishable food available for residents.

Smoke detector and carbon monoxide detectors observed operational during inspection. Fire extinguisher present with a service date of 3/15/2022. Water temperature observed to measure at 107 degrees F.

No deficiencies were observed.

Exit interview was conducted. A copy of report was given to Administrator for facility records.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2022
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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