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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209155
Report Date: 08/07/2024
Date Signed: 08/07/2024 03:40:32 PM

Document Has Been Signed on 08/07/2024 03:40 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 GUEST HOME #15FACILITY NUMBER:
107209155
ADMINISTRATOR/
DIRECTOR:
KUTNERIAN, ANGELICAFACILITY TYPE:
740
ADDRESS:2099 E. BURLINGAME AVENUETELEPHONE:
(559) 434-1839
CITY:FRESNOSTATE: CAZIP CODE:
93710
CAPACITY: 6CENSUS: 6DATE:
08/07/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Angela KutnerianTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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Licensing Program Analysts (LPA) Daiquiri Boyd arrived unannounced to conduct the Annual Inspection. LPA met with and explained the reason for the visit with Administrator (AD) Angelica Kutnerian.

During this visit, LPA toured the facility inside & out. Resident rooms contained required furnishings and lighting. The bathrooms were found to be clean with faucets delivering hot water at 115.8 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 hallway closet. Common and activity areas were clean and occupied by residents throughout. There are visitation areas available inside and out, as well as a vegetable garden. Backyard gate is alarmed and self closing. Doors and passageways are unobstructed throughout the facility. The fire extinguisher was serviced August 5, 2024. Temperature in the home was 76 degrees.

Administrator Certificate for Angelica Kutnerian expires October 5, 2025.

LPAs reviewed three resident files and two 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 14th, 2024.

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

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Daiquiri Boyd
LICENSING EVALUATOR SIGNATURE: DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/07/2024
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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