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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209370
Report Date: 10/03/2023
Date Signed: 10/03/2023 11:50:05 AM

Document Has Been Signed on 10/03/2023 11:50 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:CHATEAU JESADEANFACILITY NUMBER:
107209370
ADMINISTRATOR:ROYCHOUDHURY, MINAKSHIFACILITY TYPE:
740
ADDRESS:5633 N MAROA AVENUETELEPHONE:
(559) 499-8229
CITY:FRESNOSTATE: CAZIP CODE:
93704
CAPACITY: 6CENSUS: 6DATE:
10/03/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:03 AM
MET WITH:Licensee, Rajat Roychoudhury and Administrator, Minakshi RoychoudhuryTIME COMPLETED:
11:49 AM
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On 10/03/2023, Licensing Program Analyst (LPA) Walton conducted an announced Pre-Licensing / Component III inspection. LPA Walton introduced self, stated purpose of visit, and was allowed entry into the facility. LPA met with Administrator, Minakshi Roychoudhury certificate # 6066638740, and Licensee, Rajat Roychoudhury.

The facility is a 6 Bedroom and 3 Bathroom home and fire clearance was granted for 6, all residents may be Non-Ambulatory. This is a change of ownership inspection. There are 6 residents present during this inspection.

LPA toured the facility. Common areas were furnished and had adequate seating and lighting available. Bedrooms had required furnishings and are ready for occupancy. Resident bathrooms were checked. Bathrooms are equipped with non-skid mats and secure grab bars. Hot water measured at 117.5 degrees F. in the bathroom near bedroom #5. Hot water measured at 109 degrees F. in the bathroom between bedroom 1 and 2, and the hot water measured at 107.5 in the bathroom in bedroom 2. LPA observed an extra supply of bed linens and personal hygiene products. Kitchen was toured and observed to have dishes, plates, and utensils. Cleaning supplies and chemicals were observed in a locked cabinet. Knives are locked in a cabinet above the kitchen stove. Medications are locked in a cabinet in the kitchen. First aid kit was observed and contained all required items. A fire extinguisher was observed and has a service date of 04/10/2023. Smoke detectors and carbon monoxide were observed to be operational.

Outside of facility toured. Exits were open and free of obstructions. LPA observed side gate to be self-latching. LPA reviewed resident and staff files.

I have found that the applicant has met all pre-licensing requirements. LPA will submit documentation to CAB in Sacramento for final review prior to license being issued.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2023
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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