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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209153
Report Date: 01/14/2022
Date Signed: 01/18/2022 07:31:22 AM

Document Has Been Signed on 01/18/2022 07:31 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:VALOR IN THE WESTFACILITY NUMBER:
547209153
ADMINISTRATOR:ALVAREZ, MARIOFACILITY TYPE:
737
ADDRESS:12602 AVE 336TELEPHONE:
(661) 332-2949
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY: 4CENSUS: 0DATE:
01/14/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:58 AM
MET WITH:Administrator Mario TIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Shawna Doucette arrived to the facility announced to conduct the Pre licensing visit. LPA Shawna Doucette met with Administrator Mario Alvarez who granted LPA entry into the facility.

LPA toured facility. Common rooms have adequate furnishings and lighting. All of the resident bedrooms have all the required furnishings and adequate lighting. Hot water temperature in bathrooms measured at 110 degrees F. LPA observed a supply of extra bed linens and personal hygiene and grooming products. Kitchen observed to have dishes, plates, utensils. Cleaning supplies are stored in a locked closet. Medications are locked in a medication cabinet. First aid kit contains all the required items. A fire extinguisher is present and has a service date of 1/13/2022. Fire alarm has a complete panel for carbon monoxide, smoke alarms and sprinkler system.

Outside of the facility toured. Exits open free of obstruction, perimeter gate around facility is in place. The front of the residence is gated and has a delay egress pedestrian gate for exiting which sounds the indoor alarm. No outside hazards were observed. Facility has a pool that is fenced and locked inaccessible to clients in care.

All required postings are posted. Facility phone number will be (559) 625-6048.

Component III was conducted during pre-licensing visit with Applicants.

I have found that applicant has met all pre licensing requirements. LPA will submit documentation to CAB in Sacramento for final review prior to license being issued.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 01/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2022
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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