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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209252
Report Date: 07/01/2022
Date Signed: 07/01/2022 02:18:00 PM

Document Has Been Signed on 07/01/2022 02:18 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:CROWE HOUSE LLC, THEFACILITY NUMBER:
547209252
ADMINISTRATOR:MARTINEZ, EESAENGFACILITY TYPE:
735
ADDRESS:13274 PERRY CT.TELEPHONE:
(559) 786-1819
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY: 4CENSUS: 2DATE:
07/01/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:58 PM
MET WITH:Licensee/Administrator Eesaeng MartinezTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) K.Kaur conducted a Pre-licensing Inspection on this date. LPA met with Licensee/Administrator Eesaeng Martinez. A tour of the facility was conducted together.

The facility has 2 bedrooms designated for residents. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. Common areas were properly furnished and well-lit throughout. Fire extinguisher was observed with a service date of: 6/7/2022. Smoke detectors and carbon monoxide detector were tested and observed to be operational. The First Aid Kit was observed to have the required supplies. Medication will be kept locked in cabinets next to bathroom. Knives, cleaning supplies and chemicals will be locked in the garage until a built-in locked cabinet can be installed next to the kitchen.

The tour started in the Kitchen and proceeded to living area and resident's bedrooms. Residents' bedrooms were observed to be adequately furnished with bed, dresser, and adequate lighting. Bathrooms were properly equipped and will have trash cans with a fitting lid. Hot water was tested and was 106 F in the bathroom. Pool was observed locked. Patio has a covered sitting area and a self-latching gate was observed in the backyard. Required postings were observed. Component III was also conducted and completed.

Exit interview was conducted, report was signed on site and a printed copy of the report was provided to the Licensee.

Pre-licensing requirements were met.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 07/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/01/2022
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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