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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
107206817
Report Date:
08/30/2023
Date Signed:
08/31/2023 08:58:20 AM
Document Has Been Signed on
08/31/2023 08:58 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
FRESNO RO
,
1314 E SHAW AVE
FRESNO
,
CA
93710
FACILITY NAME:
FRESNO GUEST HOME #9
FACILITY NUMBER:
107206817
ADMINISTRATOR:
KUTNERIAN, GEORGE
FACILITY TYPE:
740
ADDRESS:
2410 E. LOS ALTOS AVE.
TELEPHONE:
(559) 434-1839
CITY:
FRESNO
STATE:
CA
ZIP CODE:
93710
CAPACITY:
6
CENSUS:
5
DATE:
08/30/2023
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
08:00 AM
MET WITH:
Angela Kutnerian
TIME COMPLETED:
11:50 AM
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This is the amended report. The original report was produced in error on the wrong facility
SUPERVISORS NAME
:
Sergiy Pidgirny
LICENSING EVALUATOR NAME
:
Miriam Flores
LICENSING EVALUATOR SIGNATURE
:
DATE:
08/30/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/30/2023
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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