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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547209358
Report Date: 04/11/2024
Date Signed: 04/11/2024 12:01:16 PM

Document Has Been Signed on 04/11/2024 12:01 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:PLUMLEE'S BOARD AND CARE #1FACILITY NUMBER:
547209358
ADMINISTRATOR/
DIRECTOR:		PLUMLEE, GEORGEFACILITY TYPE:
735
ADDRESS:2030 N BRIDGE STTELEPHONE:
(559) 733-1928
CITY:VISALIASTATE: CAZIP CODE:
93291
CAPACITY: 15CENSUS: DATE:
04/11/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:07 AM
MET WITH:George PlumleeTIME VISIT/
INSPECTION COMPLETED:
10:53 AM
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A Prelicensing visit was conducted on the date & during the times indicated above by Licensing Program Analyst (LPA) L. Xiong. LPA met with Administrator, George Plumlee.

Physical plant toured. This facility has no pool, spa, hot tub, fountains, etc.
Activity, community, & dining rooms sufficiently furnished with adequate lighting. Kitchen toured. Two (2) day supply of perishable & 7 day supply of non-perishable food on the premises. Resident rooms toured. Rooms sufficiently furnished with adequate lighting. Resident bathrooms toured. Hot water measured at 105 degrees. Interior & exterior passageway observed to be free of obstructions. Facility has a locked medication room. Outside area toured. No deficiency observed.

No outstanding issues. Component III conducted during this visit.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Les Xiong
LICENSING EVALUATOR SIGNATURE: DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/11/2024
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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