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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209251
Report Date: 01/06/2025
Date Signed: 01/06/2025 12:58:56 PM

Document Has Been Signed on 01/06/2025 12:58 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:HERITAGE CARE HOMEFACILITY NUMBER:
107209251
ADMINISTRATOR/
DIRECTOR:
KUMAR, ARUNFACILITY TYPE:
740
ADDRESS:167 W GOSHEN AVETELEPHONE:
(559) 660-2939
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY: 6CENSUS: 6DATE:
01/06/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Administrator: Kamaljit KaurTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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On 1/6/25 Licensing Program Analyst (LPA) J. Leffall arrived unannounced to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was greeted by Staff (S1) Mehkapreet Kaur. LPA was granted entry. 6 clients were present during inspection. Administrator (A1) Manprit Singh arrived shortly after. Manager (M1) Kamaljit Kaur arrived with A1 during tour.

LPA toured facility with A1. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. An adequate supply of perishable and non-perishable food was observed. Freezer temperature was maintained at -5 degrees F and refrigerator temperature was maintained at 34 degrees F. Cleaning chemicals was observed stored and locked under kitchen sink. Fire extinguisher was observed with a service date of: 1/30/24. Fire drill last completed on 12/21/24. Clients' bedrooms were toured and observed to be adequately furnished with bed, dresser, and adequate lighting. All bathrooms are toured and observed to be operational. Hot water temperature was tested at 119.4 in bathroom 1, 117.5 in bathroom 2 and 116.2 degrees in bathroom 3. Outside of facility toured. Side gate was self-closing and self-latching. Outside was observed with adequate outdoor seatings available for clients. Medications were checked and observed kept locked in medication cart. Clients’ MARS was reviewed. Carbon monoxide and smoke detectors were tested and observed to be operational. All clients’ files reviewed to have all the required documents. Samples of staff files were reviewed and observed to have all the required documents.


No deficiencies issued during this inspection.

Exit Interview conducted. The following documents requested to be updated and submitted to Fresno CCL by 1/20/24: Lic 308, Lic 500, Lic 610D, Lic 9020 and a current Administrator certificate. A copy of this report was provided to Manager, whose signature on this form confirms receipt of this report.

SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Jacques Leffall
LICENSING EVALUATOR SIGNATURE: DATE: 01/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/06/2025
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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