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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209332
Report Date: 07/06/2023
Date Signed: 07/06/2023 09:51:13 AM

Document Has Been Signed on 07/06/2023 09:51 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
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:LEGACY ADULT CARE LLCFACILITY NUMBER:
107209332
ADMINISTRATOR:MAKARYAN,HRIPSIMEFACILITY TYPE:
740
ADDRESS:2348 E HARVARD AVENUETELEPHONE:
(559) 433-7896
CITY:FRESNOSTATE: CAZIP CODE:
93703
CAPACITY: 6CENSUS: 0DATE:
07/06/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:51 AM
MET WITH:Hripsime "Kristina" Makaryan, LicenseeTIME COMPLETED:
10:00 AM
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On 7/6/23 at 8:51 AM, Licensing Program Analyst (LPA) Malia Thao arrived announced to conduct a follow-up pre-licensing inspection. LPA met with Licensee Hripsime "Kristina" Makaryan.

LPA observed fire extinguisher purchased with proof of receipt; thermometer for first aid kit; complaint poster, personal rights, and Rights of Resident Councils signs posted; and shovel and rake observed removed.

The following observed will need to be brought into compliance:
1. Hot water in hallway bathroom measured at 82 degrees F.
2. Need updated facility floor plan and yard sketch. Licensee will be submitting drafts to LPA for review.

A follow-up inspection to be scheduled once all above items are in compliance.

Exit interview conducted. A copy of this report was given to Licensee, whose signature confirms receipt of this report.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE: DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/06/2023
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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