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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107203974
Report Date: 05/12/2021
Date Signed: 05/12/2021 03:45:33 PM

Document Has Been Signed on 05/12/2021 03:45 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:PSALM 23 LOVING CARE RESIDENTIALFACILITY NUMBER:
107203974
ADMINISTRATOR:COOLEY, I'ISHAFACILITY TYPE:
735
ADDRESS:1085 W. BARSTOW AVE.TELEPHONE:
(559) 270-3822
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY: 6CENSUS: 6DATE:
05/12/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:I'Isha Cooley-LicenseeTIME COMPLETED:
12:30 PM
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On this date, Licensing Program Analyst(LPA) D. Ayers arrived at the facility unannounced to conduct a Required Annual inspection. LPA met with Licensee/Administrator I'Isha Cooley and announced the purpose of the inspection. This inspection was focused primarily on infection control due to COVID-19.

LPA toured the facility inside and outside. All passageways and exits were clear and free from obstruction. The facility was adequately furnished and well lit. LPA and Licensee reviewed infection control measures and guidelines. No deficiencies were cited during the inspection. A copy of the report was provided to the licensee. Exit interview conducted.
Andy Xiong
David Ayers
DATE: 05/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/12/2021
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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