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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 547203298
Report Date: 11/15/2024
Date Signed: 06/02/2026 03:54:02 PM

Document Has Been Signed on 06/02/2026 03:54 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:AUTUMN OAKSFACILITY NUMBER:
547203298
ADMINISTRATOR/
DIRECTOR:		ONG, ANTONIO G.FACILITY TYPE:
740
ADDRESS:848 N. JAYE STREETTELEPHONE:
(559) 784-4144
CITY:PORTERVILLESTATE: CAZIP CODE:
93257
CAPACITY: 44CENSUS: 27DATE:
11/15/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:36 PM
MET WITH:Lisa OngTIME VISIT/
INSPECTION COMPLETED:
07:22 PM
NARRATIVE
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“This report is being amended to update the reporting manager.”


On this date, L. Xiong was at the above facility for a case management visit. A tour of the facility was conducted.

The following deficiency is in violation of title 22 div. 6 CCR.
NAME OF LICENSING PROGRAM MANAGER: Alexandria Walton
NAME OF LICENSING PROGRAM ANALYST: Les Xiong
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2024
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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Document Has Been Signed on 06/02/2026 03:54 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 06/02/2026 03:54 PM


Created By: Les Xiong On 11/15/2024 at 06:18 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: AUTUMN OAKS
FACILITY NUMBER: 547203298

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/22/2024
Section Cited
CCR
87303a

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“This report is being amended to update the reporting manager.”

MAINTENANCE AND OPERATIONS - The facility shall be clean, safe, sanitary and in good repair at all times. The facility has/had bed bugs. Also, mattress cover was not in good repair.
This poses an immediate Health and Safety risk to clients in care.
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Facility already has contract with Sierra Vista Exterminators for monthly Pest Control services to treat facility. On 10/22/24 when bedbugs was discovered, the facility was treated for bedbugs and a subsequent treatment was treated on 11/4/24. New mattress covers were ordered for the rooms that were treated. No further correction for the bedbugs treatment, however pictures need to be sent to licensing for once the mattress covers and put on the mattress of the rooms being treated.

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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:Alexandria Walton
LICENSING EVALUATOR NAME:Les Xiong
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2024


LIC809 (FAS) - (06/04)
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