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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208932
Report Date: 02/27/2024
Date Signed: 02/27/2024 02:47:18 PM

Document Has Been Signed on 02/27/2024 02:47 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:MORGAN VALLEY RESIDENCEFACILITY NUMBER:
107208932
ADMINISTRATOR:CAUCHI, NANCYFACILITY TYPE:
740
ADDRESS:1676 E. ESCALON AVETELEPHONE:
(559) 365-8664
CITY:FRESNOSTATE: CAZIP CODE:
93710
CAPACITY: 3CENSUS: 2DATE:
02/27/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Nancy CauchiTIME COMPLETED:
03:00 PM
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On 02/27/2024, Licensing Program Analyst (LPA) M. Flores arrived unannounced to continue the required annual inspection. LPA and Licensing Program Manager, Sergiy Pidgirny explained reason for inspection and was granted entry by caregiver staff. Licensee, Nancy Cauchi arrived at the facility about thirty- minutes later.
During the visit a file review and interviews were completed for residents and staff files.

Exit interview was conducted with Licensee, Nancy Cauchi, whose signature confirms receipt of this report.

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Miriam Flores
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2024
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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