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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209252
Report Date: 10/17/2023
Date Signed: 10/17/2023 06:03:24 PM

Document Has Been Signed on 10/17/2023 06:03 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:
10/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
04:15 PM
MET WITH:Administrator (Admin) Eesaeng Martinez; Assistant Administrator (AA) Eehai See;TIME COMPLETED:
06:15 PM
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An unannounced Annual visit was conducted on the date & times indicated above by Licensing Program Analyst (LPA) K. McClurg. LPA arrived @ facility & received answer to doorbell through doorbell from Administrator (Admin) Eesaeng Martinez. Admin stated that they were away from home with clients. Admin stated that they would have on-call person Assistant Administrator (AA) Eehai See come to facility. AA arrived @ facility & met with LPA.

Facility home telephone number is (559) 713-6985.
Partial physical plant toured. Duration of visit spent reviewing compliance expectations, communication with LPA, reporting requirements, etc. Additional inspection information reviewed @ time of visit, including Infection Control, Operational Requirements, Staffing, Client Rights-Information, Disaster Preparedness, etc.
Annual visit to be completed at a later date.

Exit interview conducted with AA. Report provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2023
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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