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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209456
Report Date: 08/10/2024
Date Signed: 08/10/2024 12:08:33 PM

Document Has Been Signed on 08/10/2024 12:08 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:G AND R HOMEFACILITY NUMBER:
107209456
ADMINISTRATOR/
DIRECTOR:
GLORIA, SARAFACILITY TYPE:
740
ADDRESS:6219 E SUSSEX WAYTELEPHONE:
(559) 444-3806
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY: 6CENSUS: 0DATE:
08/10/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:59 AM
MET WITH:Dianne Receno
Sara Gloria
TIME VISIT/
INSPECTION COMPLETED:
12:25 PM
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On 8/10/24, Licensing Program Analyst (LPA) M. Medina conducted an announced Pre-licensing inspection. LPA introduced self, stated the purpose of the visit, and was granted entry into the facility. LPA met with Licensees Dianne Receno and Sara Gloria. LPA toured facility with licensees, The facility is 5 bedroom and 2 bathroom home. Fire clearance granted for 3 ambulatory residents.

Inside of tour conducted, common areas were furnished and had adequate seating and lighting available. Facility temperature observed at 78 degrees F. All bedrooms were observed to have required furnishings. Kitchen was toured and observed to have dishes, plate, and utensils. Facility has 7-day supply of non-perishable food available as of date of inspection. Knives to be locked and secured in kitchen drawer. Medication will be locked and secured in kitchen cabinet.

Outside of facility toured. LPA observed exit gate on west side of facility to not be self latching and side fence in need of repair. Area along east side of facility has shower doors, ladder, 5-gallon paint cans, ladders, and some boxes that need to be removed. Ramps utilized at exits need to be secured to avoid potential accidents.

Cleaning supplies and chemicals will be locked and secured in cabinet in garage. Fire extinguisher present with a purchase date of 3/06/24. Smoke detectors and carbon monoxide detectors were observed to be operational during this inspection. Water temperature measured at 114 degrees F. First Aid kit present and . has all required items. First Aid book available. Facility has a new phone number of (559) 319-6196, and observed operational at time of inspection.

LPA will conduct follow-up pre-licensing visit once the following items have been completed:

1) Exit gate on west side of facility needs to be self-latching

2) Side fence on west side of facility needs repair

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 08/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/10/2024
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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: G AND R HOME
FACILITY NUMBER: 107209456
VISIT DATE: 08/10/2024
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3) Area along east side of facility has shower doors, ladder, 5-gallon paint cans, ladders, and some boxes that need to be removed.

4) Ramps utilized at all exit doors need to be secured to avoid potential accidents

LPA will conduct follow-up inspection when repairs and completed.

Component III conducted with licensees during pre-licensing inspection.

No deficiencies cited during today's inspection.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2024
LIC809 (FAS) - (06/04)
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