<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206935
Report Date: 10/14/2024
Date Signed: 10/14/2024 12:51:13 PM

Document Has Been Signed on 10/14/2024 12:51 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:FRESNO GUEST HOME #10FACILITY NUMBER:
107206935
ADMINISTRATOR/
DIRECTOR:		LONG, TERESAFACILITY TYPE:
740
ADDRESS:6590 N JACKSON AVENUETELEPHONE:
(559) 434-1839
CITY:FRESNOSTATE: CAZIP CODE:
93710
CAPACITY: 6CENSUS: 6DATE:
10/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:59 AM
MET WITH:Teresa LongTIME VISIT/
INSPECTION COMPLETED:
01:05 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 10/14/24, Licensing Program Analysts (LPAs) D. Boyd and M. Medina conducted an unannounced Annual Inspection. LPAs introduced self, stated purpose of visit, and allowed entry. LPAs conducted facility tour with Administrator Teresa Long. LPA Medina did file review for residents and staff and documented on a separate report.

Facility tour began in resident rooms. Facility observed to be clean, odor free and maintained at a comfortable temperature. There is ample seating in all areas of the facility for residents. LPA observed resident rooms to be well lit. Water temperature measured 117 degrees F. Grab bars and nonskid mats or surfaces were observed in all of the resident bathrooms. The common areas, activities room and dining room were all toured. Kitchen toured, LPA observed a 2-day supply of perishable and 7-day supply of non-perishable food available as well as Emergency Supply food. Daily menus are posted in dining areas with alternate options available. Residents observed throughout community in dining areas, common lounge areas, and participating in various activities.

All needed postings were observed on the dining room wall. Fire extinguisher all have current service dates of 08/04/2024. Carbon monoxide detectors observed operational during today's visit. Last fire drill conducted on 09/01/24.

Resident and staff interviews conducted. LPA received update LIC 500, copy of liability insurance, and LIC 610E during facility inspection.

No deficiencies observed.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Daiquiri Boyd
LICENSING EVALUATOR SIGNATURE: DATE: 10/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/14/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1