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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247206253
Report Date: 07/14/2021
Date Signed: 07/14/2021 03:44:29 PM

Document Has Been Signed on 07/14/2021 03:44 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:INTEGRATED HEALTH CARE LLCFACILITY NUMBER:
247206253
ADMINISTRATOR:TIU, JERRYFACILITY TYPE:
740
ADDRESS:1503 ESPLANADE DRIVETELEPHONE:
(209) 383-4767
CITY:MERCEDSTATE: CAZIP CODE:
95348
CAPACITY: 6CENSUS: 0DATE:
07/14/2021
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME BEGAN:
01:07 PM
MET WITH:Jerry Tiu, AdministratorTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Lady Cabrera conducted an Annual Inspection on this date. LPA was met by Administrator Jerry Tiu and stated the purpose of the visit. Administrator reported the facility renovations were completed and at this time the facility is still vacant. A tour of the facility was conducted.

No deficiencies were observed. Exit interview was conducted. Administrator was informed that as a COVID-19 precautionary measure, this report will be emailed.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Lady Cabrera
LICENSING EVALUATOR SIGNATURE: DATE: 07/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/14/2021
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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