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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209239
Report Date: 10/31/2024
Date Signed: 11/01/2024 12:21:52 AM

Document Has Been Signed on 11/01/2024 12:21 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:JAN-ROY PLACE OF FRESNO 2FACILITY NUMBER:
107209239
ADMINISTRATOR/
DIRECTOR:		HOPPER, JOYCELYN B.FACILITY TYPE:
740
ADDRESS:4266 N 9TH STREETTELEPHONE:
(559) 940-9708
CITY:FRESNOSTATE: CAZIP CODE:
93726
CAPACITY: 6CENSUS: DATE:
10/31/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:30 PM
MET WITH:Assistant Administrator (AA) Kirgil Roy MendozaTIME VISIT/
INSPECTION COMPLETED:
05:30 PM
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An Annual visit was conducted by Licensing Program Analyst (LPA) K. McClurg.

Physical Plant toured. Kitchen appeared to be clean & organized. Knives & cleaning products in separate locked areas making inaccessible to residents. Sufficient supply of perishable & nonperishable food on the premises. Dining & living room sufficiently furnished. Furnishings appeared to be in good repair. Sufficient lighting. Resident bedrooms appeared to be sufficiently furnished with items in good repair & adequate lighting. Linens on beds & additional supplies available as needed. Resident bathroom appeared & smelled to be clean with no unpleasant odors. Fixtures operational. Grab Interior passageways & exits observed to be clear with no obstructions, including exit door in each resident bedroom. Smoke & carbon dioxide detectors operational

Medications observed to be inaccessible to clients & organized. Medication Administration Records (MARs) & Centrally Stored Medication & Destruction Records (CSMDRs) documentation completed & maintained. Resident files maintained. Staff files maintained.

Exit interview conduced with AA. Report provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kelly J. McClurg
LICENSING EVALUATOR SIGNATURE: DATE: 10/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2024
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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