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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208801
Report Date: 07/19/2022
Date Signed: 07/19/2022 03:33:18 PM

Document Has Been Signed on 07/19/2022 03:33 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 XIFACILITY NUMBER:
107208801
ADMINISTRATOR:ANGELICA KUTNERIAN GLESSFACILITY TYPE:
740
ADDRESS:2562 E MAGILL AVENUETELEPHONE:
(559) 434-1839
CITY:FRESNOSTATE: CAZIP CODE:
93710
CAPACITY: 6CENSUS: 6DATE:
07/19/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Angela Kutnerian, Administrator and George Kutnerian, Chief Executive OfficerTIME COMPLETED:
03:45 PM
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Licensing Program Manager (LPM) Sergiy Pidgirny and Licensing Program Analyst (LPA) Lady Cabrera met with Administrator Administrator and George Kutnerian, Chief Executive Officer to review Theft and Loss Policy.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Lady Cabrera
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2022
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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