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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209100
Report Date: 06/18/2021
Date Signed: 06/18/2021 03:12:27 PM

Document Has Been Signed on 06/18/2021 03:12 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:FRESNO GUEST HOME #14FACILITY NUMBER:
107209100
ADMINISTRATOR:KUTNERIAN, GEORGEFACILITY TYPE:
740
ADDRESS:2118 E FREMONT AVE.TELEPHONE:
(559) 434-1839
CITY:FRESNOSTATE: CAZIP CODE:
93710
CAPACITY: 6CENSUS: 6DATE:
06/18/2021
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Angela Kutnerian, AdministratorTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) L. Cabrera arrived unannounced for a Post Licensing Inspection. LPA met with Administrator Angela Kutnerian. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Licensee.

A tour of the facility was conducted: Facility appeared clean and was odor free. All rooms had required furnishings and adequate lighting. The facility was at a comfortable temperature. Passageways were free from obstruction inside and out. Residents' rooms were toured and inspected. Rooms were found to be clean. Hot water temperature was measured 101 F, Advisory was given.

No fire hazards observed. Kitchen toured, adequate supply of food observed, and food stored properly. Medications were stored in a locked closet. Knives were stored in a locked closet. Adequate linen supply observed in hall cabinets. Cleaning supplies were stored in a locked cabinet. First Aid Kit contained the required supplies. Smoke detectors and carbon monoxide detectors were checked and operating. Fire extinguishers were charged and had service dates of 4/20/21. Fire drill was last completed on 06/01/2021.

Resident, medication and staff records were reviewed and found to be complete. Current first aid and CPR were on file for staff.

LPA observed a self-latching gate on the outside of the residence. There was outdoor seating for the residents.



No deficiency was observed regarding the inspection. Exit Interview conducted.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Lady Cabrera
LICENSING EVALUATOR SIGNATURE: DATE: 06/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/18/2021
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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