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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209349
Report Date: 10/11/2023
Date Signed: 10/12/2023 10:52:41 AM


Document Has Been Signed on 10/12/2023 10:52 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:AILE ASSISTED LIVINGFACILITY NUMBER:
547209349
ADMINISTRATOR:CERVANES, ARMANDOFACILITY TYPE:
740
ADDRESS:1542 E. GLENWOOD AVENUETELEPHONE:
(408) 420-7538
CITY:TULARESTATE: CAZIP CODE:
93274
CAPACITY:6CENSUS: 3DATE:
10/11/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Armando Cervantes, Administrator TIME COMPLETED:
11:45 AM
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On 10/11/23, Licensing Program Analyst (LPA) L. Salazar arrived at the facility for an announced Change of Ownership Pre-licensing inspection. LPA met with Administrator Armando Cervantes and toured the facility inside and out. LPA observed 3 residents in care at the time of inspection. The facility was observed to be clean and in good repair. No passageway obstructions or fire hazards were observed inside or outside. Common areas were properly furnished and well-lit throughout. The dining room is equipped with a table and chairs, living room is equipped with adequate sofas and chairs for residents, adequate outside space for rest and recreational under a covered patio.

Perishable and non-perishable food supply appeared adequate. There are no dementia residents in care at this time. Medication and cleaning supplies will be kept locked in the laundry room. Residents' bedrooms were observed to be adequately furnished with bed, dresser, chair and adequate lighting. Mattresses and linen were in good condition. Extra linen and towels are available. Hot water temperature measured at 105 degrees F. Carbon monoxide and smoke alarm detectors installed and operational. Grab bars installed in showers and by toilets, non-skid mats in place, hand soap and paper towels available for use.

Fire extinguisher was serviced and fully charged. Complaint poster posted, resident council info posted, residents' rights posted, emergency disaster plan posted. Gate is self-closing and self-latching.

Component III was also conducted and completed. Exit interview was conducted. Pre-licensing requirements were met. An exit interview was conducted with Administrator. Report signed on-site by Administrator and printed copy provided at the time of this visit.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2023
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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