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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107200719
Report Date: 07/27/2021
Date Signed: 07/27/2021 04:02:31 PM

Document Has Been Signed on 07/27/2021 04:02 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:VALLEY CHRISTIAN HOME IIFACILITY NUMBER:
107200719
ADMINISTRATOR:GAMUEDA, HONORAFACILITY TYPE:
740
ADDRESS:504 W. MESATELEPHONE:
(559) 438-1009
CITY:FRESNOSTATE: CAZIP CODE:
93704
CAPACITY: 6CENSUS: 6DATE:
07/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Honora Gamueda, Licensee/AdministratorTIME COMPLETED:
12:45 PM
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On 7/27/21 at 11:45 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct an Annual inspection. LPA was greeted by Licensee/Administrator Honora "Nora" Gamueda and granted entry. Five residents were present.

Facility was observed clean and without any obstructions or fire clearance issues. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common and dining areas. Hand washing posters were observed by the bathroom sinks. Bedrooms were checked and no residents share a room. LPA checked residents’ medications and observed the month's supply. Food supply was observed in adequate supply. Cleaning and PPE supplies were checked. Staff records were reviewed for good health. Residents files have updated emergency contact information. Administrator certification is pending renewal. Recertification application mailed 4/5/21 and is awaiting for renewed administrator certificate.

No deficiencies cited during inspection.

Exit interview was conducted. A copy of this report was emailed to Licensee Honora Gamueda at nora.gamueda@gmail.com with read receipt to confirm receipt of this report.
SUPERVISORS NAME: Andy Xiong
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE: DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/27/2021
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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