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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107201840
Report Date: 02/05/2025
Date Signed: 02/05/2025 05:28:03 PM

Document Has Been Signed on 02/05/2025 05:28 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:MARIAN HOMES 3FACILITY NUMBER:
107201840
ADMINISTRATOR/
DIRECTOR:		JANARDHAN NAGARAJFACILITY TYPE:
740
ADDRESS:3238 JASMINE AVENUETELEPHONE:
(559) 384-3580
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY: 6CENSUS: 1DATE:
02/05/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Administrator: Shannon SteeleTIME VISIT/
INSPECTION COMPLETED:
06:00 PM
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On 2/5/25 Licensing Program Analyst (LPA) J. Leffall arrived unannounced to conduct an Annual Inspection. LPA introduced himself, stated the purpose of the visit, and was greet by Administrator (A1) Shannon Steele (A1) LPA was granted entry. 0 residents were present during inspection. 1 resident who resides in facility is currently residing in another facility. This facility is currently conducting renovations inside the property.

LPA toured facility with A1. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. An adequate supply of perishable and non-perishable food was observed. No resident’s medications were checked because there are no residents present. No clients’ MARS were reviewed. Cleaning chemicals was observed stored and locked in facility cabinet. Fire extinguisher was observed with a service date of: 7/2/24. Fire drill last completed on 1/15/25. Clients' bedrooms were toured and observed to be adequately furnished with bed, dresser, and adequate lighting. All bathrooms are toured and observed to be operational. Hot water temperature was tested at a range of 107.4 to 108.1 degrees in 2 bathrooms.

Outside of facility toured. Outside observed free of debris. Side gate was self-closing and self-latching. Outside was observed with adequate outdoor seatings available for clients. Freezer temperature was maintained at 0 degrees F and refrigerator temperature was maintained at 39 degrees F. Carbon monoxide and smoke detector were tested and observed to be operational. All clients’ files reviewed to have all of the required documents. All staff files were reviewed to have all required documents.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Jacques Leffall
LICENSING EVALUATOR SIGNATURE: DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/05/2025
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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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: MARIAN HOMES 3
FACILITY NUMBER: 107201840
VISIT DATE: 02/05/2025
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No deficiencies issued during this inspection.

Exit Interview conducted. LPA is requesting the following documents be submitted to the Fresno CCL office by 2/19/25: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance-RCFE, Emergency and Disaster Plan (LIC 610E -RCFE), Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020A- RCFE)

A copy of this report was provided to A1, whose signature on this form confirms receipt of this report.

SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Jacques Leffall
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025
LIC809 (FAS) - (06/04)
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