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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209323
Report Date: 01/21/2025
Date Signed: 01/21/2025 04:51:08 PM

Document Has Been Signed on 01/21/2025 04:51 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:SEQUOIA GROVE ASSISTED LIVING, INCFACILITY NUMBER:
107209323
ADMINISTRATOR/
DIRECTOR:
KEGHOUHY HANDIANFACILITY TYPE:
740
ADDRESS:787 E. MINARETS AVETELEPHONE:
(559) 449-1249
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY: 6CENSUS: 5DATE:
01/21/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Administrator - Keghoushy HandianTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) M. Vega arrived at the facility unannounced to conduct a required annual
visit at 1:00 pm and met with Administrator - Keghouhy Handian explained the reason for the visit. Entrance interview conducted. Census of 5 residents with capacity of 6.

Beginning at 1:10pm, the LPA, along with the Administrator - Keghouhy Handian toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed:

The Kitchen and Dining area were clean and sanitary and in good repair. All pathways observed were free of obstruction and hazards. Knifes and sharp objects were locked in drawer and inaccessible to residents. The refrigerator and freezer were within operating temperature, 43 F and 0 F. They are also clean and sanitary with no spoiled food. There were at least 2 days of perishable food and 7 days of non-perishable food stored. Fire extinguishers are fully charged and were last serviced 06/24//24.

Hardwired smoke and carbon monoxide detectors and fire doors were tested and operational and all were functional at the time of the visit. LPA observed exit alarms by all doors which were functional and operating.

At about 2:20pm walked though residents rooms, observed All bedrooms had the required furnishing: Lamps, Chairs, a Bed, and storage for clients' clothing. All bedrooms were sanitarily clean and free from trip hazards.

Report Continued on LIC 809-C
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Martin Vega
LICENSING EVALUATOR SIGNATURE: DATE: 01/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/21/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: SEQUOIA GROVE ASSISTED LIVING, INC
FACILITY NUMBER: 107209323
VISIT DATE: 01/21/2025
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All bedrooms were in good repair. Medications are locked in a closet located near the hallway. Cleaning supplies are stored in a locked cabinet in the laundry room. At about 4:30pm the bathroom water temperature was tested for one of the residents bathrooms. An outdoor seating area was observed operational for residents in care.

LPA reviewed Staff and Resident files. Resident files observed to have updated information.
No deficiencies were observed and cited. Exit interview conducted.

Report was signed and copy of this report was provided for facility records.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Martin Vega
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2025
LIC809 (FAS) - (06/04)
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