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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209293
Report Date: 03/28/2024
Date Signed: 03/28/2024 06:28:03 PM

Document Has Been Signed on 03/28/2024 06:28 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:PEOPLE'S CARE DEEP CREEK COURTFACILITY NUMBER:
547209293
ADMINISTRATOR:ESCOBEDO, JONATHANFACILITY TYPE:
737
ADDRESS:17287 DEEP CREEK COURTTELEPHONE:
(559) 667-9975
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY: 4CENSUS: 3DATE:
03/28/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Administrator (Admin) Jonathan Escobedo TIME COMPLETED:
07:00 PM
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An Annual visit was conducted on the date & times above by Licensing Program Analyst (LPA) K. Mcclurg. LPA met with Administrator (Admin) Jonathan Escobedo.

Facility toured. Sufficient furnishings & lighting in front sitting room, dining room & living room. Kitchen toured. Knives locked. Cabinets under kitchen sink observed to be locked making cleaners, etc. inaccessible. Sufficient amount of food on the premises. Food calculation process reviewed @ time of visit. Sufficient supply of service ware & utensils observed.

Resident rooms toured. Sufficient furnishings & adequate lighting. Resident bathrooms toured. Fixtures functional. Hot water tested & measured @ 118 Degrees F. Medications observed to be centrally stored in locked cabinet. Facility passageways observed to be clear & free of obstructions. Smoke & carbon monoxide detectors operational. Fire extinguisher service date: 2/7/24.

Outside area toured. Sufficient seating available. Yard maintained. Fences in good repair.

Visit to be continued at a later date.

Exit interview conduced with Admin. Report provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE: DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2024
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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