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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209332
Report Date: 07/13/2023
Date Signed: 07/13/2023 08:55:01 AM

Document Has Been Signed on 07/13/2023 08:55 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:
07/13/2023
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
08:29 AM
MET WITH:Hripsime "Kristina" Makaryan, LicenseeTIME COMPLETED:
09:05 AM
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On 7/13/23 at 8:29 AM, Licensing Program Analyst (LPA) Malia Thao arrived announced to conduct a follow-up prelicensing inspection. LPA met with Licensee Hripsime "Kristina" Makaryan.

LPA measured hot water in hall bathroom at 107.1 degrees F.

All licensing requirements have been met. LPA will notify CAB of prelicensing inspection completion. CAB will finalize application and submit license to Licensee once the application process has been completed.

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: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2023
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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