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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209293
Report Date: 05/25/2023
Date Signed: 05/25/2023 09:34:47 AM

Document Has Been Signed on 05/25/2023 09:34 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
SIERRA CASCADE AC/SC, 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: 2DATE:
05/25/2023
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Rachel Sanchez, DSP IITIME COMPLETED:
09:55 AM
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On 5/25/23 at 8:30 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct a collateral visit. LPA explained reason for inspection and was granted entry. Administrator (ADM) Jonathan Escobedo was not available for the inspection but was available by telephone. ADM gave permission for staff DSP II Rachel Sanchez to sign today's report.

LPA interviewed resident (R1).

No deficiencies cited during today's inspection.

Exit interview conducted. A copy of this report was left with DSP II Rachel Sanchez, whose signature confirms receipt of this report.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2023
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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