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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209365
Report Date: 01/18/2024
Date Signed: 01/22/2024 08:37:20 AM

Document Has Been Signed on 01/22/2024 08:37 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
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:
01/18/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
03:07 PM
MET WITH:Jaswant (Rubie) Bajwa, LicenseeTIME COMPLETED:
05:07 PM
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Licensing Program Analyst (LPA) L. Padgett arrived or announced reinspection of this facility. LPA met with Licensee, Jaswant (Rubie) and Balwinder Kaur and toured the facility. Common areas have adequate furnishings and lighting. All 4 client bedrooms have the required furnishings, bed linens, proper lighting and smoke detectors. LPA observed a supply of extra bed linens, towels, and personal
hygiene and grooming products. Non-Skid mats are available, soap, paper towels present along with storage available for client personal items.
Kitchen observed to have supply of dishes, plates, utensils, pots and pans. Food storage and preparation areas are clear and appropriate for food preparation. Cleaning supplies and chemicals are locked in the lower kitchen cabinet and in locked cabinet in garage. Sharps/knives in a lock drawer in the kitchen. Appliances observed to be in working order. LPA observed a 7 day of non-perishable food stored in a pantry. Licensee has designated a locked cabinet in the laundry room. First aid kit contains all the required items. Washer and Dryer observed in the laundry room with additional storage space available. Doors and passageways are unobstructed throughout the home.
AD has addressed the following:
Utensils sufficient for 6 residents
Proof of Fire Extinguisher purchased on 1/11/2024.
Posting of Fire Clearance, PUB 475, Resident rights, Visiting Policy
Lock sharps/knives in locked cabinet or box
Provide paper towels for bathrooms
Purchase adequate food supply for 7 days
Install grab bars in shower
Install night lights in hallway
Purchase personal hygiene products, sufficient for 6 residents.
continued on 809C
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Lissett Padgett
LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2024
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: 01/18/2024
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In regards to the elevated floor planks in bedroom 5, licensee has decided to use this room as a staff rooom and will place rug over planks until they are replaced. Licensee will submit updated facility sketch to LPA by tomorrow.
The applicant has met all pre-licensing requirements. LPA will submit documentation to CAB in Sacramento
for final review prior to license being issued.

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: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024
LIC809 (FAS) - (06/04)
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