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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209293
Report Date: 03/11/2025
Date Signed: 03/11/2025 05:42:42 PM

Document Has Been Signed on 03/11/2025 05:42 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/
DIRECTOR:		ESCOBEDO, JONATHANFACILITY TYPE:
737
ADDRESS:17287 DEEP CREEK CTTELEPHONE:
(559) 667-9975
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY: 4CENSUS: 3DATE:
03/11/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Assistant Administrator (AA) Regan Lockett; Administrator (Admin) Jonathan EscobedoTIME VISIT/
INSPECTION COMPLETED:
06:00 PM
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An Annual visit was conducted on the date & times indicated above by Licensing Program Analyst (LPA) K. McClurg. LPA met with Assistant Administrator (AA) Regan Lockett @ facility. Administrator (Admin) Jonathan Escobedo. LPA stated purpose of visit & was allowed to proceed with visit. Fire cleared for fully fenced & for delayed egress. Facility telephone on premises operational.
Facility has internet service.

Physical plant toured. Living & dining rooms sufficiently furnished with adequate lighting. Kitchen area toured. Two (2) day supply of perishable & 7 day supply on non-perishable food on the premises, in addition to food for meals between shopping. Knives observed to be locked. Sufficient supply of service ware & utensils. Appliances appeared to be clean. Kitchen counters replaced during past year. Current counters are solid surface & easy to clean & sanitize.

Client bedrooms toured. Each client has their own bedroom. Bedrooms sufficiently furnished with adequate lighting. Client bathrooms toured. Working fixtures. Appeared & smelled clean with no unpleasant odors. Hot water in client bathroom on east side of house tested & measured at 116 degrees F. Hot water in client bathroom on west side of house tested & measured at 117 degrees F. Sufficient supply of lines available.


Continued
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 COURT
FACILITY NUMBER: 547209293
VISIT DATE: 03/11/2025
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Continued

Additional living room on west end of house, next to west bedroom sufficiently furnished with adequate lighting. Back storage area observed to be locked & back stock of additional care products for clients such deodorant, shampoo, body wash, etc. Laundry room appeared to be clean with washer & dryer functional. Laundry supplies maintained in locked area making inaccessible to clients.

Garage & backyard. Garage currently being used as an additional activity area. Refrigerator appeared to be clean with freezer section not overly full preventing air circulation. Backyard appears to be appropriately maintained & tidy. Sufficiently furnished with significant room for variety activities.

Facility records reviewed. Medications observed to be locked, & organized. Centrally Stored Medication & Destruction Record (CSMDR) reviewed & appeared to be sufficiently maintained. Medication Administrator Record (MARs) reviewed & appeared to be sufficiently maintained. Medication stored consistent with medication records.

Sufficient supply of Personal Protective Equipment (PPE) on premises. Cleansers, disinfectants, etc. inaccessible. Interior & exterior passageways observed to be clear & free of obstructions. Facility temperature comfortable: no addition layers or need to remove any layers. Smoke & carbon monoxide detectors tested & observed to be operational. Fire extinguisher service date: 1/20/25.

Exit interview conducted with AA. Report provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025
LIC809 (FAS) - (06/04)
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