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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209394
Report Date: 02/02/2024
Date Signed: 02/02/2024 09:31:35 AM

Document Has Been Signed on 02/02/2024 09:31 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:FRESNO GUEST HOME #20FACILITY NUMBER:
107209394
ADMINISTRATOR:KUTNERIAN, ANGELICAFACILITY TYPE:
740
ADDRESS:2165 E MENLO AVENUETELEPHONE:
(559) 434-1839
CITY:FRESNOSTATE: CAZIP CODE:
93710
CAPACITY: 6CENSUS: 0DATE:
02/02/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Angelica KutnerianTIME COMPLETED:
09:45 AM
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A Pre-Licensing visit was conducted on the scheduled date and times indicated above by Licensing Program Analyst (LPA) M. Flores. LPA met with Licensee, Angelica Kutnerian and Administrator, Teresa Long. Application documents as applicable for Pre-Licensing were reviewed at the time of visit.

Facility phone: (559) 512-5551. Physical plant toured. Facility is clean and in good repair. Interior and exterior passageways are free of obstructions. Items that could pose a danger, such as disinfectants and cleaning solutions are inaccessible and locked in the laundry room. Sufficient lighting and furnishings were noted in the kitchen, dining, living, and resident bedrooms. Locked centralized storage area for medications is next to the kitchen. First aid kit is complete. Hot water tested & measured at 112.6 degrees F. Room temperature measured at 72 degrees. Physical plant is consistent with the facility sketch/floor plan. Fire extinguisher was purchased on 10/18/23. Smoke & carbon monoxide detectors tested & determined to be operational.

Comp III was waived.

Pre-Licensing is complete & this facility has no deficiencies.

Exit interview conducted and a copy of this report was provided to Licensee, Angelica Kutnerian.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Miriam Flores
LICENSING EVALUATOR SIGNATURE: DATE: 02/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/02/2024
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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