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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208977
Report Date: 06/11/2021
Date Signed: 07/01/2021 12:46:29 PM

Document Has Been Signed on 07/01/2021 12:46 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:JAN-ROY PLACE OF FRESNOFACILITY NUMBER:
107208977
ADMINISTRATOR:HOPPER, JOYCELYNFACILITY TYPE:
740
ADDRESS:4766 EAST ILLINOIS AVETELEPHONE:
(559) 940-9708
CITY:FRESNOSTATE: CAZIP CODE:
93702
CAPACITY: 6CENSUS: 6DATE:
06/11/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:TIME COMPLETED:
03:30 PM
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On 6/11/2021, Licensing Program Analyst (LPA) A. Walton arrived unannounced to conduct an Annual Inspection. LPA was met by staff Ana Marie Gregoria, introduced self, and stated the purpose of the visit. Administrator was not available to met with LPA during this inspection. LPA received verbal permission from Licensee, Jocelyn Hopper to conduct the inspection with facility staff. Facility has one entrance/exit point. Visitor log-in/temperature check was upon entry.

Facility appeared clean with no obstruction or fire clearance issues. Hand sanitizer was available to residents and visitors. Social distancing is maintained in the common and dining areas. Hand washing posters were observed by the bathroom sink. Bedrooms were checked and beds are six feet apart.



LPA checked residents’ locked medications. Food supply was checked. Cleaning and PPE supplies were checked. Facility has an adequate supplies of required PPE. Staff records were reviewed for good health and infection control training. Facility staff was observed with mask on. Residents wear masks when away from the facility. Resident’s files have updated emergency contact information. Administrator certification is current.

No deficiencies were observed. Exit interview was conducted. Administrator was informed that as a COVID-19 precautionary measure, a copy of this report will be provided via email and an electronic read receipt confirms receiving this document. Facility Representative signature on file.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 06/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/11/2021
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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