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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208983
Report Date: 07/12/2021
Date Signed: 07/12/2021 02:59:08 PM

Document Has Been Signed on 07/12/2021 02:59 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:SOMERFORD PLACE-FRESNOFACILITY NUMBER:
107208983
ADMINISTRATOR:FOWLER, JENNIFERFACILITY TYPE:
740
ADDRESS:6075 N. MARKSTELEPHONE:
(559) 446-6226
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY: 64CENSUS: 46DATE:
07/12/2021
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Jennifer Fowler - Executive DirectorTIME COMPLETED:
01:30 PM
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On this date, Licensing Program Analyst (LPA) David Ayers arrived unannounced to conduct a Case Management inspection. LPA identified himself and discussed the purpose of the visit with Executive Director Jennifer Fowler. The purpose of the visit was to verify the health and safety of residents in the facility.

LPA toured the facility and interviewed residents. LPA observed residents being served lunch. LPA observed adequate supply of food stuffs and incontinence supplies. LPA verified facility staffing and record-keeping procedures. No deficiencies were cited during the inspection. A copy of the report was provided via email. Exit interview conducted.
SUPERVISORS NAME: Andy Xiong
LICENSING EVALUATOR NAME: David Ayers
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2021
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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