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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208848
Report Date: 02/11/2025
Date Signed: 02/11/2025 01:10:05 PM

Document Has Been Signed on 02/11/2025 01:10 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:EVERSPRING RETIREMENT HOMEFACILITY NUMBER:
107208848
ADMINISTRATOR/
DIRECTOR:		AZADEH AKBARNEJADFACILITY TYPE:
740
ADDRESS:5738 N. LOLA AVETELEPHONE:
(559) 907-2596
CITY:FRESNOSTATE: CAZIP CODE:
93722
CAPACITY: 6CENSUS: 6DATE:
02/11/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:50 AM
MET WITH:Alex BabakhaniTIME VISIT/
INSPECTION COMPLETED:
01:21 PM
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On 2/11/2025, Licensing Program Analyst (LPA) M. Medina arrived to conduct an unannounced Annual Inspection. LPA arrived, stated purpose of visit, and allowed entrance by staff. LPA met with Alex Babakhani, Licensee/Administrator to conduct today's inspection.

Facility tour conducted with Licensee. Facility is 5 bedroom, 2 bathroom room home, and also has a room that is utilized for staff/office. Facility observed to be clean, odor free, a comfortable temperature, and well lit. Residents observed to be seated in the living room watching television, and others relaxing in their bedrooms. Facility tour began in resident bedrooms. All resident bedrooms observed furnished with all required furnishings and well lit. Resident bathrooms toured, all fixtures observed operational. Toilet and shower area observed to have grab bars. Facility has non-skid mats available in the tub/shower for residents. Water temperature measured at 120 degrees F at time of inspection. Kitchen toured, LPA observed all knives and sharps to be in locking kitchen drawer. Facility has a 2-day supply of perishable food and a 7-day supply of non-perishable food available. All foods in the refrigerator observed to be properly stored and labeled at time of inspection. Facility has adequate seating in both the living room area and dining room for residents in care. Medications observed to be locked and secured in the kitchen under the kitchen island. All medications observed to have original labels and to be administered as prescribed. Facility utilizes Caring Data Program to log and administer medications and track all resident information. First Aid kit present and observed to have all required items.

All cleaning supplies and locked and secured in a cabinet in the garage. Garage has a locking door from the interior of the laundry room that is inaccessible to residents. Carbon monoxide and smoke detectors observed operational at time of inspection. Fire extinguisher present with a purchase date of 4/11/2024. Last fire drill conducted 1/02/25 and last disaster drill conducted 1/09/2025 according to facility records.
SUPERVISORS NAME: Alexandria Walton
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/11/2025
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: EVERSPRING RETIREMENT HOME
FACILITY NUMBER: 107208848
VISIT DATE: 02/11/2025
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Outside of facility toured. Side gate designated as emergency exit is self latching and free of obstruction. Facility has a outside seating area with shade for residents in care.

Resident and staff files reviewed.

No deficiencies observed during inspection.

LPA received the following documents during today's inspection: Copy of Administrator's Certificate, Copy of Liability Insurance, Designation of Facility Responsibility (LIC 308), Administrative Organization (LIC 309), Affidavit Regarding Client/Resident Cash Resources (LIC 400), Surety Bond (LIC 402), Personnel Record (LIC 500), Register of Facility Clients/Residents (LIC 9020).

Exit interview conducted and a copy of this report provided for facility records.
SUPERVISORS NAME: Alexandria Walton
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025
LIC809 (FAS) - (06/04)
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