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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206935
Report Date: 10/14/2024
Date Signed: 10/14/2024 12:50:21 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 10/14/2024 12:50 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
CCLD Regional Office, 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:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:59 AM
MET WITH:Teresa LongTIME VISIT/
INSPECTION COMPLETED:
01:05 PM
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On 10/14/24, Licensing Program Analysts (LPAs) M. Medina and D. Boyd arrived to the facility unannounced to conduct the required annual inspection. LPAs stated the purpose of the visit and were allowed entry into the facility. LPAs met with Administrator, Teresa Long and conducted the facility tour.

LPA Medina reviewed a sample of staff and resident files and observed the files to have the required documentation and staff training's. LPA reviewed Emergency Disaster plan and observed the binder to have the required updated information.

LPA Boyd will document the physical plant tour and inspection tool results on a separate report.

No deficiencies cited.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
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)
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