<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209205
Report Date: 06/20/2024
Date Signed: 06/20/2024 08:45:34 PM

Document Has Been Signed on 06/20/2024 08:45 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 #16FACILITY NUMBER:
107209205
ADMINISTRATOR/
DIRECTOR:
KUTNERIAN, GEORGEFACILITY TYPE:
740
ADDRESS:6859 N. CHANCE AVENUETELEPHONE:
(559) 434-1839
CITY:FRESNOSTATE: CAZIP CODE:
93710
CAPACITY: 6CENSUS: 6DATE:
06/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:35 PM
MET WITH:Angela KutnerianTIME VISIT/
INSPECTION COMPLETED:
06:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 6/20/24, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required Inspection. LPA introduced self, stated purpose of visit and allowed entrance. LPA met with Administrator, Angela Kutnerian (ADM1) and Administrator, Teresa Long (ADM2) to conduct facility inspection.

Facility tour conducted with ADM1. Facility observed to be a comfortable temperature, clean, and well lit. Facility has six (6) private bedrooms. All bedrooms observed to have all required accommodations for residents. Resident bathrooms toured, all bathrooms observed to have grab bars, shower chairs and non-skid mats available. Water temperature observed to be 118 degrees. Kitchen toured, LPA observed stove knobs to be off and secured in kitchen drawer. Sharps are locked and secured. Facility observed to have a 2-day supply of perishable food and a 7-day supply of non-perishable food available. LPA observed medications to be locked and secured in kitchen pantry. Medications observed to have original labels and be administered as prescribed. All chemicals observed to be locked in a closet in the laundry room.

Outside of facility toured. All exits open free of obstruction. Exit gate is self latching. Seating area available for residents. No hazards observed.

Fire extinguisher present with a service date of 8/02/23. Smoke and Carbon Monoxide detectors are dual units and observed operational at time of inspection. Last fire drill conducted 6/01/2024 according to facility records.

LPA reviewed resident and staff files. LPA requested the following forms to be submitted to Fresno Regional Office no later than 7/03/24: Personnel Report (LIC 500), Client Roster (LIC 9020), and current liability insurance.

No deficiencies were cited during this inspection. Exit interview was conducted and a copy of this report will be emailed to facility.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1