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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208977
Report Date: 07/29/2022
Date Signed: 07/29/2022 10:58:32 AM

Document Has Been Signed on 07/29/2022 10:58 AM - 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: 4DATE:
07/29/2022
TYPE OF VISIT:POCANNOUNCEDTIME BEGAN:
10:14 AM
MET WITH:Assistant Administrator, Roy MendozaTIME COMPLETED:
11:10 AM
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On 07/29/2022, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct a POC visit. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. Administrator, Joycelyn Hopper is not available to meet with LPA during this visit. LPA met with Assistant Administrator, Roy Mendoza.

On 06/21/2022, LPA conducted an annual inspection at the above facility. During the inspection the facility was issued 2 citations based on California Code of Regulations section 87303(a) and 87555(b)(26). Administrator agreed to repair facility blinds, repair/secure window screens, and stock the facility with a minimum two day supply of perishable foods.

During today's visit, LPA conducted a facility tour. LPA observed a two day supply of perishable foods. LPA did not observe the window screens in the living rooms and bedroom 1 and bedroom 3 to be in good condition.

Administrator was given a correction date of 07/21/2022.

Based on observation, a civil penalty in the amount of $100 per day per citation is being assessed for Failure to Correct until facility submits proof of correction to the Fresno CCL office, see LIC421FC. An exit interview was conducted. A copy of this report and appeal rights were provided to Assistant Administrator, Roy Mendoza, whose signature on this form confirms receipt of this document.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 07/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/29/2022
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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