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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209327
Report Date: 03/14/2025
Date Signed: 03/14/2025 03:57:32 PM

Document Has Been Signed on 03/14/2025 03:57 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:GROVE HOME LLC, THEFACILITY NUMBER:
547209327
ADMINISTRATOR/
DIRECTOR:		MARTINEZ, EESAENGFACILITY TYPE:
735
ADDRESS:3413 E GROVE AVETELEPHONE:
(559) 786-1819
CITY:VISALIASTATE: CAZIP CODE:
93292
CAPACITY: 4CENSUS: 4DATE:
03/14/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Administrator (Admin) Eesaeng MartinezTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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An unannounced Case Management visit was conducted by Licensing Program Analyst (LPA) K. McClurg. LPA met with Administrator (Admin) Eesaeng Martinez, stated purpose of visit & was allowed to proceed with visit.

Purpose of this visit was to review recent SIR about client's (C1) recent behavioral episode as occurred while at program & follow up that occurred on 3/11/25.
Incident reviewed & discussed, including information as reported appropriately to the Department. Facility appears to have followed policies & procedures including reporting & arranging additional support resources with Central Valley Regional Center (CVRC) for C1..

No additional concerns @ this time.
Exit interview conduced with Admin. Report provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2025
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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