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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209239
Report Date: 10/07/2022
Date Signed: 10/07/2022 03:13:36 PM

Document Has Been Signed on 10/07/2022 03:13 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:JAN-ROY PLACE OF FRESNO 2FACILITY NUMBER:
107209239
ADMINISTRATOR:HOPPER, JOYCELYN B.FACILITY TYPE:
740
ADDRESS:4266 N 9TH STREETTELEPHONE:
(559) 940-9708
CITY:FRESNOSTATE: CAZIP CODE:
93726
CAPACITY: 6CENSUS: 5DATE:
10/07/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Licensee, Joycelyn HopperTIME COMPLETED:
11:34 AM
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Licensing Program Analyst (LPA) Darius Williams and LPA Vadim Gorban conducted a Pre licensing visit. LPA's met with Licensee, Joycelyn Hopper and discussed the purpose of the visit.

LPA's entered facility through the front and were screened for Covid-19 symptoms. LPA's conducted toured of the facility with Licensee.

LPA Williams observed no obstructions or bodies of water in the front yard. The designated side gate exit was self latching and free of obstruction.

The living room was clean and had space to accommodate clients.

Utensils, plates, cups, bowls, and cook ware were present in the kitchen. The stove, microwave, and refrigerator were all functional. Next to the kitchen was a dining table with seating for 6 individuals.

Rooms 1, 2, 3, all had beds, with mattresses, mattress cover, linens, blanket, pillow, and pillow case. All bed rooms had dressers, lights, chair, and were clean, and in good repair.

The bathrooms were equipped with non-slip mats, grab bars near the toilet and in the shower, clean, and in good repair.

LPA Williams observed a supply of personal hygiene items, linens, washcloths, and towels.

*Continued on LIC 809-C*

SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Darius Williams
LICENSING EVALUATOR SIGNATURE: DATE: 10/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/07/2022
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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: JAN-ROY PLACE OF FRESNO 2
FACILITY NUMBER: 107209239
VISIT DATE: 10/07/2022
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The backyard had a covered seating area.

The garage was clean, in good repair, and utilized for extra storage of supplies.

LPA Williams observed knives, chemicals, and designated medication storage area, locked and inaccessible to residents.

Fire extinguisher was present, last check date of 4/22/2022, and charged. Both the smoke detectors and carbon monoxide detector were present and functional.

Pre-licensing is complete with no corrective measures.

LPA Williams completed Component III with the Licensee.

A License has not been issued to the Licensee at this time. This report has been provided to Central Applications Bureau for further action.

An exit interview was conducted and a copy of this report was provided to the Licensee.
SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Darius Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022
LIC809 (FAS) - (06/04)
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