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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209153
Report Date: 04/10/2024
Date Signed: 04/12/2024 10:53:20 AM

Document Has Been Signed on 04/12/2024 10:53 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/
DIRECTOR:
AMAYA, RUDY M.FACILITY TYPE:
737
ADDRESS:12602 AVE 336TELEPHONE:
6613322949
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY: 4CENSUS: 3DATE:
04/10/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:29 AM
MET WITH:Lead Staff Lexi Rankin and Administrator Rudy AmayaTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analyst Shawna Doucette (LPA) arrived at the facility unannounced to conduct a Required Annual inspection. LPA was met by Lead Staff Lexi Rankin and was granted entry into the facility. Administrator Rudy Amaya responded to the facility to assist with the visit.

LPA conducted a tour inside and outside of facility. Facility observed to be clean, and at a comfortable temperature. Facility was set at 72 F. Common areas were furnished well with adequate seating and lighting available. Facility has 4 bedrooms. Facility has a living room and an activity room. Kitchen toured, appeared clean and safe for food preparation. Food supply checked, LPA observed an adequate supply of food. Resident rooms checked. LPA observed an adequate supply of linen. Hot water measured at 108 degrees F. Exterior tour conducted, all exits open and free of obstructions. Side gate was observed to be self-latching and goes out to an alley.

Fire extinguisher serviced on 12/28/2023. Smoke detectors and carbon monoxide detectors observed operational during today’s inspection. Fire alarm is hard wired with sprinkler system. Facility has a pull station fire alarm. Last fire drill conducted 3/14/2024. All cleaning supplies are locked and secured in a closet. Medications were locked in a medication cart in the office.

Facility has a pool which was being serviced during the visit. LPA observed a lock on the gate to make the pool inaccessible to residents.

Medications were reviewed. Staff files and Resident files were reviewed.

An exit interview was conducted with the Administrator and a copy of this report was provided.

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 04/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/10/2024
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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