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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209063
Report Date: 08/05/2024
Date Signed: 08/06/2024 07:29:10 AM

Document Has Been Signed on 08/06/2024 07:29 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:FRESNO GUEST HOME #13FACILITY NUMBER:
107209063
ADMINISTRATOR/
DIRECTOR:
KUTNERIAN, ANGELICAFACILITY TYPE:
740
ADDRESS:2076 E FREMONT AVETELEPHONE:
(559) 434-1839
CITY:FRESNOSTATE: CAZIP CODE:
93710
CAPACITY: 6CENSUS: 6DATE:
08/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Angelica KutnerianTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analysts (LPA) Daiquiri Boyd arrived unannounced to conduct the Annual Inspection. Facility staff greeted LPA and advised that they have called the Administrator and she would arrive shortly. LPA met with, and explained the reason for the visit with, Administrator (AD) Angelica Kutnerian.

During this visit, LPA toured the facility inside & out. Facility has a large storage area in the back of the property for extra supplies including non-perishable foods. Resident rooms contained required furnishings and lighting. The bathrooms were found to be clean with faucets delivering hot water at 106 degrees. LPA observed required hygiene items, towels, extra bedding, and linens which were stored and available for use. The kitchen was clean, with necessary items and appliances. LPA observed required food supply and paper product storage. Medications are locked and centrally stored in a locked closet off of the back of the kitchen.

Common and activity areas were clean and occupied by residents throughout. There are visitation areas available inside and out. Doors and passageways are unobstructed throughout the facility. The Fire extinguisher was purchased on January 16, 2024. Refill is currently scheduled for August 5, 2024 for the alternate extinguisher. Temperature in the home was 75 degrees.

LPAs reviewed three resident files and three staff files. All files had required documents.

LPAs requested Licensee to submit the following documents: LIC308, LIC309, LIC500, Proof of Liability Insurance, and facility sketch by August 12th, 2024.

No deficiencies were cited on this day. LPAs conducted an exit interview with Administrator.

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Daiquiri Boyd
LICENSING EVALUATOR SIGNATURE: DATE: 08/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/05/2024
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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