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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208977
Report Date: 09/01/2023
Date Signed: 09/01/2023 11:01:23 AM

Document Has Been Signed on 09/01/2023 11:01 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: 5DATE:
09/01/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator, Kir Gilroy MendozaTIME COMPLETED:
11:06 AM
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On 09/01/2023, Licensing Program Analyst (LPA) Walton and Auditor Chapman (AUD) arrived unannounced to conduct a case management visit. LPA and AUD introduced themselves and requested to meet with the Administrator. LPA and AUD were granted entry to the facility and met with Administrator, Kir Gilroy Mendoza.

During today's visit, resident records and P&I records were reviewed.

AUD is requesting P&I supporting documents (ledger from the county) and bank statements for R1, R2, and R3 from the date of admission to present to be submitted to the Fresno CCL office by 09/08/2023.

No deficiencies issued during today's inspection.

Exit interview conducted. A copy of this report was discussed and provided to Administrator, Kir Gilroy Mendoza, whose signature on this form confirms receipt of this document.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 09/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/01/2023
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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