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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209293
Report Date: 03/09/2023
Date Signed: 03/10/2023 09:17:46 AM

Document Has Been Signed on 03/10/2023 09:17 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:PEOPLE'S CARE DEEP CREEK COURTFACILITY NUMBER:
547209293
ADMINISTRATOR:ESCOBEDO, JONATHANFACILITY TYPE:
737
ADDRESS:17287 DEEP CREEK COURTTELEPHONE:
(909) 287-3557
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY: 4CENSUS: 0DATE:
03/09/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Jonathan Escobedo (Admin) Administrator; Henry Trochez (DM) District Manager; TIME COMPLETED:
06:00 PM
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An Pre-Licensing visit was conducted on the time & date by Licensing Program Manager (LPA) K. McClurg. LPM met with Jonathan Escobedo (Admin) Administrator & Henry Trochez (DM) District Manager.

Facility phone: (559) 667-9975. Physical plant toured. Regulations reviewed. Facility is clean & in good repair. Interior & exterior passageways free of obstructions. Items that could pose a danger, such as disinfectants, cleaning solutions, etc., are inaccessible. Sufficient lighting & furnishings in dining, living, & resident bedrooms. Locked centralized storage area for medications. First aid kit complete. Hot water tested & measured at 118 degrees F. Physical plant is consistent with the facility sketch/floor plan. Fire extinguisher service date: 3/1/2023. Smoke & carbon monoxide detectors tested & determined to be operational.

A Component III was conducted.

Pre-Licensing is complete and this facility has no deficiencies

Exit interview conducted with Admin & DM. Report provided at time of visit.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE: DATE: 03/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/09/2023
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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