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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209163
Report Date: 08/22/2023
Date Signed: 08/22/2023 03:48:56 PM

Document Has Been Signed on 08/22/2023 03:48 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:FARMER RESIDENTIAL HOMEFACILITY NUMBER:
547209163
ADMINISTRATOR:FARMER, RHONDIFACILITY TYPE:
735
ADDRESS:1061 S ROYAL OAKTELEPHONE:
(559) 920-2975
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY: 4CENSUS: 4DATE:
08/22/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
01:36 PM
MET WITH:Rhondi FarmerTIME COMPLETED:
03:52 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
LPA came back to the facility to complete the facility's annual inspection started on 8/21/23. LPA reviewed facility's records during the visit.

Through LPA’s observations, documentation review and interview with Licensee, the required infection control practices are found to be in compliance. There is no deficiency cited for this visit.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Les Xiong
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2023
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 1