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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209379
Report Date: 02/11/2025
Date Signed: 02/11/2025 01:50:29 PM

Document Has Been Signed on 02/11/2025 01:50 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:ATTENTIVE SENIOR CARE IV LLCFACILITY NUMBER:
107209379
ADMINISTRATOR/
DIRECTOR:		HOLLAND, PAULETTEFACILITY TYPE:
740
ADDRESS:1829 S FARIWAY AVENUETELEPHONE:
(559) 540-7235
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY: 6CENSUS: 0DATE:
02/11/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Paulette Holland TIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 02/11/2025, Licensing Program Analyst (LPA) R Bruce arrived to conduct an annual inspection. LPA introduced self, stated the purpose of the visit, and met with Licensee Paulette Holland.

There are currently no clients residing at the facility. A pre licensing inspection was completed on 2/28/24. No issues noted at this time. A post licensing inspection will be conducted when residents are placed.

At this visit, LPA conducted a tour inside and outside of facility. Facility observed to be clean, odor free and at a comfortable temperature. Common areas were furnished well with adequate seating and lighting available. Resident rooms appeared clean and had required furnishings. Resident bathrooms were properly equipped with securely fastened grab bars in toilet and tub/shower areas, non-skid mats were observed. Kitchen toured, appeared clean.

Exterior tour conducted, all exits open and free of obstructions.
Fire extinguisher serviced in December 2024. Smoke detectors and carbon monoxide detectors observed operational during today’s inspection. All cleaning supplies will be locked as well as medication when residents are present.

There are no staff or client files to review. Upon acquiring a resident, CCL will conduct post licensing inspection. No citations issued at today's visit.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Rachel A Bruce
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2025
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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