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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209230
Report Date: 01/03/2025
Date Signed: 01/03/2025 11:40:38 AM

Document Has Been Signed on 01/03/2025 11:40 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:STANFORD COTTAGE ASSISTED LIVINGFACILITY NUMBER:
107209230
ADMINISTRATOR/
DIRECTOR:
VASQUEZ, MARTHAFACILITY TYPE:
740
ADDRESS:2202 STANFORD AVETELEPHONE:
(559) 375-1687
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY: 6CENSUS: 5DATE:
01/03/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Administrator-Martha VasquezTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 1/3/25, Licensing Program Analyst (LPA) J. Leffall arrived unannounced to conduct an annual visit.
LPA introduce self, stated the purpose of the visit and met Staff (S1) Roxana Benitez and greeted upon arrival. Administrator Martha Vasquez (A1) arrived shortly after arrival. (A1) toured facility with LPA. 4 clients were present during inspection. 1 resident is currently in the hospital.

The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway
obstructions or fire hazards were observed inside or outside. An adequate supply of perishable and
non-perishable food was observed. Fire extinguisher was observed with a purchase date of 12/18/24. Fire drill last completed: 12/11/24. The temperature is maintained for refrigerator at 35 degrees F and freezer at 5
degrees F. Medications observed locked in locked cabinet. MARs were reviewed. Cleaning supplies and chemicals stored and in storage cabinet. All bedrooms were observed to have the required furnishings and with adequate lightening. The bathrooms were toured. Bathrooms were observed operational during inspection. Bathrooms contained grab bars and non-skid mats in showers. Hot water temperature was tested at 112.6 degrees F in the bathroom 1 and 109.2 degrees F in bathroom 2. Outside of facility toured and observed to be free of debris. Side gate observed self-closing and self-latching. Swimming pool observed locked and inaccessible to clients. Adequate outdoor seatings available for clients. Carbon monoxide and smoke detectors were tested and observed to be operational. All clients’ files were reviewed to have all the required documents. Staff files were also reviewed to have all required documents.

No deficiencies cited during inspection.

Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 1/17/25. Forms requested: Lic 308, Lic 309, Lic 500, Lic 610D, Lic 9282, current Administrator certificate, and control of property. A copy of this report was provided to Administrator, whose signature on this form confirms receipt of this report.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Jacques Leffall
LICENSING EVALUATOR SIGNATURE: DATE: 01/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/03/2025
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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