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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209116
Report Date: 02/20/2025
Date Signed: 02/20/2025 07:06:39 PM

Document Has Been Signed on 02/20/2025 07:06 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:FRESNO SENIOR LIVINGFACILITY NUMBER:
107209116
ADMINISTRATOR/
DIRECTOR:		MONTELONGO, BRANDONFACILITY TYPE:
740
ADDRESS:1715 E ALLUVIAL AVENUETELEPHONE:
(559) 298-4900
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY: 100CENSUS: 63DATE:
02/20/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:50 PM
MET WITH:Administrator - Brandon MontelongoTIME VISIT/
INSPECTION COMPLETED:
07:30 PM
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On 02/20/25, Licensing Program Analyst (LPA) M Vega arrived at the facility unannounced to conduct Required Annual Inspection. LPA was greeted by receptionist and stated the purpose of the visit. LPA met with Executive Director (ED) - Brandon Montelongo. LPA conducted tour of facility with ED. Residents were observed throughout the facility post lunch. Some residents were in the main lobby area playing bingo as well.

The facility was observed to be at a comfortable temperature, 72-75 degrees Fahrenheit throughout the facility. The facility was observed to be clean, in good repair, and no passageway obstructions or fire hazards observed. Fire extinguisher was observed with a service date of 02/03/2025 - 29/100.

Dining area and Kitchen were toured. An adequate supply of perishable and non-perishable food was observed to be properly stored in walk-in freezer, walk-in refrigerator, and pantry. Refrigerator temperature was maintained at 40-degree F. and freezer was maintained at -5-degree F.

LPA toured a sample of resident bedrooms. Residents' rooms were toured and observed with adequately furnished with bed, dresser, and adequate lighting. LPA toured laundry room and observed chemicals were stored and locked.
Hot water temperature tested at 120 degrees F. LPA observed securely fastened grab bars and non-skid mat in all shower areas.

Medications were stored in a locked medication room in a medication cart. Medications records were reviewed to be accurate at time of inspection.

Report continued LIC 809C
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Martin Vega
LICENSING EVALUATOR SIGNATURE: DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: FRESNO SENIOR LIVING
FACILITY NUMBER: 107209116
VISIT DATE: 02/20/2025
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Facility courtyard was toured and observed to be free from debris. There was outdoor seating available for the residents.

A sample of residents’ file was reviewed to have updated files. A sample of staff files were reviewed. Staff files were observed to have current records. Staff are fingerprinted clear and associated to the facility.



LPA requested following files:

LIC 308 Designation of Facility Responsibility
LIC 309 Administrative Organization
LIC 400 Affidavit Regarding Client/Resident Cash Resources
LIC 402 Surety Bond
LIC 500 Personnel Report
LIC 610E Emergency Disaster Plan For Residential Care Facilities For The Elderly
LIC 9020 Register of Facility Clients/Residents
Copy of current Liability Insurance
Copy of current Administrator Certificate
Alternate contact information including name, telephone number, & email address.

An exit interview was conducted with the ED. No deficiencies issued during this inspection.
A copy of this report was provided to the ED, whose signature on this form confirm receipt of this report.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Martin Vega
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
LIC809 (FAS) - (06/04)
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