<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 207202624
Report Date: 05/05/2022
Date Signed: 05/05/2022 01:43:29 PM

Document Has Been Signed on 05/05/2022 01:43 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:FARR'S FAMILY FACILITY-ELDERLYFACILITY NUMBER:
207202624
ADMINISTRATOR:FARR, GENEVAFACILITY TYPE:
740
ADDRESS:104 SASSAFRAS DRIVETELEPHONE:
(559) 661-4275
CITY:MADERASTATE: CAZIP CODE:
93637
CAPACITY: 6CENSUS: 0DATE:
05/05/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Geneva Farr , Licensee TIME COMPLETED:
01:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 05/05/22, Licensing Program Analyst (LPA) L. Salazar and Licensing Program Manager (LPM) M. Hoffmann arrived at the facility unannounced to conduct a final walk through on the facility. Live-in Caregiver, Noah Farr, was present upon arrival.

On 04/22/2022, LPA received a plan of correction via fax stating the Licensee (L1) is surrendering their license effective 04/22/2022. All resident's in the home were relocated by their responsible party prior to the surrender of the license.

Licensee was unavailable to come to the facility so LPA and LPM drove to Licensee's personal residence to finalize this report.


SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 05/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/05/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1