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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209365
Report Date: 01/08/2024
Date Signed: 01/08/2024 12:25:59 PM

Document Has Been Signed on 01/08/2024 12:25 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:BK HOUSE OF GRACE 2 LLCFACILITY NUMBER:
107209365
ADMINISTRATOR:BAJWA, JASWANTFACILITY TYPE:
740
ADDRESS:5742 EAST LORENA AVETELEPHONE:
(559) 515-6726
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY: 6CENSUS: 0DATE:
01/08/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:18 AM
MET WITH:Jaswant Bajwa, LicenseeTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Lissett Padgett arrived at the facility to conduct the Pre-Licensing Inspection. LPA met with Administrator (AD) Jaswant “Ruby” Bajwa.
LPA began the tour by entering through the front door of the 5 bedroom/2 bathroom/1 story home. Interior common areas have adequate furnishings and lighting. All 5 client bedrooms have the required beds, night stands with drawers and closet space. All bedrooms lacked chest of drawers for each resident.
LPA was unable to determine if there are adequate bed linens as items were in bags and in various locations in the facility.
Smoke and Carbon Monoxide detectors were tested and observed to be in working order. LPA observed a adequate supply of towels. There was an inadequate supply of personal hygiene and grooming products. There were no paper towels in the bathrooms. Hot water temperature in bathroom measured at 120 degrees F. Non-Skid mats present in the showers. AD states she has purchased grab bars for the shower. AD will inform LPA when these have been installed.
Kitchen observed to have supply of dishes, plates, pots and pans. LPA observed utensils serving for 4, AD will purchase utensils sufficient for 6 residents. Food storage and preparation areas are clear and appropriate for food preparation. Cleaning supplies and chemicals are locked in the garage cabinet. Sharps/knives do not yet have a designated locked location. AD will address this issue. Appliances observed to be in working order. LPA observed did not observed a 7 day supply of non-perishable food. AD plans to store medications in locked cabinet in the laundry room. First aid kit contains all the required items. A fire extinguisher is present but did not have a purchase or expiration date.
Washer and Dryer observed in the laundry room with additional storage space available in upper cabinets.

See Lic.809-C for continuation of report.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Lissett Padgett
LICENSING EVALUATOR SIGNATURE: DATE: 01/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/08/2024
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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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: BK HOUSE OF GRACE 2 LLC
FACILITY NUMBER: 107209365
VISIT DATE: 01/08/2024
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Doors and passageways are unobstructed throughout the home. Outside of the facility toured. There is a covered gazebo seating area and a self-latching gate found to be working properly. The home does not have a pool.
LPA called and confirmed the facility phone number by calling (559) 515-6726

The following observed will need to be brought into compliance:
Chest of drawers for each resident
Utensils sufficient for 6 residents
Proof of Fire Extinguisher in compliance
Posting of Fire Clearance, PUB 475, Resident rights, Visiting Policy
Repair broken tile in bathroom
Lock sharps/knives in locked cabinet or box
Repair elevated floor planks in home
Provide paper towels for bathrooms
Purchase adequate food supply for 7 days
Replace mattress for 1 bed in bedroom 4
Install grab bars in showers
Install night lights in hallway
Purchase personal hygiene products, sufficient for 6 residents

An exit interview was conducted and a copy of this report was left with AD, whose signature confirms receipt of these documents.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Lissett Padgett
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2024
LIC809 (FAS) - (06/04)
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