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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 167209143
Report Date: 07/21/2021
Date Signed: 07/22/2021 03:49:06 PM

Document Has Been Signed on 07/22/2021 03:49 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:SPARKS' RESIDENTIAL MEADOW BROOKFACILITY NUMBER:
167209143
ADMINISTRATOR:SPARKS, CEIARAFACILITY TYPE:
740
ADDRESS:983 S GREEN STREETTELEPHONE:
(559) 772-8385
CITY:HANFORDSTATE: CAZIP CODE:
93230
CAPACITY: 6CENSUS: 3DATE:
07/21/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Ceiara Sparks-LicenseeTIME COMPLETED:
01:00 PM
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On this date, Licensing Program Analyst(LPA) D. Ayers arrived at the facility for an announced Pre-licensing Inspection. LPA met with Licensee Ceiara Sparks.

LPA toured the facility inside and outside. All passageways and exits were clear and free from obstruction. The facility was adequately furnished, well-lit, and at a comfortable temperature. LPA observed smoke and carbon-monoxide detectors. Sharp items and cleaning supplies were secured in a locked cabinet in the pantry area. Medications were secured in a locked chest of drawers in the living room. LPA observed an adequate supply of perishable and non-perishable food stuffs. LPA toured resident bedrooms and bathrooms and observed bedrooms to have required minimum furnishings. Bathrooms have secure grab bars and non-skid mats. Outdoor area was free from hazards and had enough seating for all residents. Facility is licensed for 6 ambulatory residents.

Licensee completed Component III Orientation. No deficiencies were cited during the inspection. A copy of this report was provided to the licensee via email.
SUPERVISORS NAME: Andy Xiong
LICENSING EVALUATOR NAME: David Ayers
LICENSING EVALUATOR SIGNATURE: DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2021
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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