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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 355202348
Report Date: 08/03/2022
Date Signed: 08/04/2022 06:51:07 AM

Document Has Been Signed on 08/04/2022 06:51 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:CLEARVIEW CAREHOMES,INC.FACILITY NUMBER:
355202348
ADMINISTRATOR:FELICIDAD RAMOS KANKELBORGFACILITY TYPE:
740
ADDRESS:3370 CIENEGA ROADTELEPHONE:
(831) 637-4463
CITY:HOLLISTERSTATE: CAZIP CODE:
95023
CAPACITY: 6CENSUS: 5DATE:
08/03/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Licensee/Administrator Felicidad Ramos KankelborgTIME COMPLETED:
09:15 AM
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Licensing Program Analyst LPA conducted a Case Management to check change in facility sketch. LPA was met by Licensee/Administrator Felicidad Ramos Kankelborg and discussed the purpose of the visit.

LPA toured the facility and reviewed change in facility sketch. Room #2 changed from a staff room to a resident room.

An exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/03/2022
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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