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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209013
Report Date: 10/11/2024
Date Signed: 10/14/2024 01:18:23 PM

Document Has Been Signed on 10/14/2024 01:18 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:ATTENTIVE SENIOR CARE II, LLCFACILITY NUMBER:
107209013
ADMINISTRATOR/
DIRECTOR:
HOLLAND, LAWRENCEFACILITY TYPE:
740
ADDRESS:6149 E LOWE AVETELEPHONE:
(916) 996-6215
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY: 6CENSUS: 6DATE:
10/11/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Paulette Holland, LicenseeTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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On October 11, 2024, Licensing Program Analyst (LPA) R. Bruce arrived unannounced to conduct a Required 1 year Annual Inspection. LPA introduced self, stated the purpose of the visit and requested to meet with Administrator. Paulette Holland was available, left for a portion of the visit and returned at conclusion of inspection.

Visitor log-in/temperature check, masks, and disinfection station were observed upon entry. Facility has one entrance/exit point. Facility appeared clean and obstruction of fire clearance issues. LPA observed the Fire extinguisher located in the kitchen with a service date February, 2023. All bathrooms observed with trash cans that have lids, and securely fastened grab bars. Showers have non-skid mats. All resident’s rooms toured and observed to be adequately furnished and lit. LPA observed 3 shared resident’s bedrooms.


The exterior tour was conducted. Side gate was self-closing and self-latching. There is extra equipment, paint and misc. items that are stored in a shed which is locked.

Staff records were reviewed and all required documentation was present. Three out of six resident's records were reviewed and found to be in compliance. LPA checked residents’ locked medications. Food supply was checked and appeared to be an adequate supply. Water temperatures in kitchen and bathrooms tested and within range per regulations.

LPA is requesting the following documents be submitted to the Fresno CCL office by November 1, 2024. Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Emergency and Disaster Plan, Personnel Report (LIC500), Register of Facility Clients/Residents for LIC9020.

An exit interview was conducted with Licensee. Report signed on-site by licensee; a copy of this report, will be provided via email as printer is not functioning.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Rachel A Bruce
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2024
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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