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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
107209267
Report Date:
01/03/2024
Date Signed:
04/17/2024 11:43:12 AM
Document Has Been Signed on
04/17/2024 11:43 AM
- 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:
HOME IS WHY LLC
FACILITY NUMBER:
107209267
ADMINISTRATOR:
TEASLEY, DEANGELA
FACILITY TYPE:
740
ADDRESS:
5364 E. MCKENZIE
TELEPHONE:
(334) 652-9491
CITY:
FRESNO
STATE:
CA
ZIP CODE:
93727
CAPACITY:
6
CENSUS:
4
DATE:
01/03/2024
TYPE OF VISIT:
Case Management - Deficiencies
UNANNOUNCED
TIME BEGAN:
08:30 AM
MET WITH:
DeAngela Santos, Administrator
TIME COMPLETED:
01:15 PM
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This is an Amended Report for the unannounced annual inspection conducted at this facility on 1/3/2024. No deficiencies cited.
SUPERVISORS NAME
:
Sergiy Pidgirny
LICENSING EVALUATOR NAME
:
Lissett Padgett
LICENSING EVALUATOR SIGNATURE
:
DATE:
04/12/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
04/16/2024
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
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Document is an Amendment of
Original Document
on
02/29/2024 09:18 AM
Created By:
Lissett Padgett
On
01/03/2024
at
12:42 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO
,
1314 E SHAW AVE
FRESNO
,
CA
93710
FACILITY NAME:
HOME IS WHY LLC
FACILITY NUMBER:
107209267
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
01/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:
Sergiy Pidgirny
LICENSING EVALUATOR NAME:
Lissett Padgett
LICENSING EVALUATOR SIGNATURE:
DATE:
01/03/2024
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/03/2024
LIC809
(FAS) - (06/04)
Page:
2
of
2