<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209483
Report Date: 12/06/2024
Date Signed: 07/29/2025 02:34:38 PM

Document Has Been Signed on 07/29/2025 02:34 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:CLOSE TO HOME RESIDENTIAL CAREFACILITY NUMBER:
107209483
ADMINISTRATOR/
DIRECTOR:		AMBRIZ, EMILYFACILITY TYPE:
740
ADDRESS:5852 E BURNS AVETELEPHONE:
(559) 708-8822
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY: 6CENSUS: 5DATE:
12/06/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Emily Ambriz, Administrator TIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 12/6/2024, Licensing Program Analyst (LPA) Rachel Bruce arrived at the facility to conduct a Pre-Licensing Inspection. LPA met with Administrator (AD) Emily Ambriz. This facility has been operating since July 2023. There was a substantiated complaint of unlicensed care and as a result the application process has been completed. Today's visit is considered pre-licensing and that care tool was utilized at today's visit. Subsequent post licensing visit will be conducted as soon as license is provided and areas of concern are addressed.

LPA began the tour by entering through the front door of the 4 bedroom - 2 bathroom – one story home. All required postings were hung. Common areas were found to be well lit. Furniture was observed to be properly spaced and in good condition. Flooring is intact throughout the home. Smoke and Carbon Monoxide detectors were tested and found to be in working order. The Fire Extinguishers (located near kitchen and in garage) were serviced May 2024. LPA observed additional supply of paper products, bed linens, towels, personal hygiene/grooming products. Resident rooms are found to be in good repair and contained required linens, furnishings, adequate closet space and lighting. The resident bathrooms are clean, in good repair with grab bars and faucets delivering hot water at 110 degrees.

The kitchen was observed to have a supply of dishes, plates, utensils and cooking items. Food storage areas are clear and appropriate for food preparation. Cleaning supplies, chemicals, and sharps/knives are all locked as required. Appliances were found to be in working order. Resident medications will be stored and locked in kitchen closet. The First aid kit contains all the required items. Doors and passageways are unobstructed throughout the inside and outside of the home.

continued
NAME OF LICENSING PROGRAM MANAGER: Sergiy Pidgirny
NAME OF LICENSING PROGRAM ANALYST: Rachel A Bruce
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: CLOSE TO HOME RESIDENTIAL CARE
FACILITY NUMBER: 107209483
VISIT DATE: 12/06/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Outside of the facility was toured. There is a covered seating area and plenty of space to recreate. There is a built in pool which has an appropriate secured fence. There is a storage shed in the backyard. AD unlocked the shed and LPA observed inside. Garage contains two refrigerators for overflow of food, and locked cabinets to store soap, chemicals and cleaning supplies.

Emergency Disaster and Infection Control Plans were reviewed and COMP III was conducted during this visit with AD.

LPA counseled AD on issues that need to be addressed before licensure. The following issues are to be addressed immediately. Once completed AD will contact LPA for post licensing visit/inspection.
  • Food supply- there were 2 days of perishable fresh food but there was not a seven day supply of non-perishible items for 4 residents
  • Exit gate is not self latching. AD will shave the bottom of the gate to ensure it closes without assistance.\
  • Camera in front bedroom is non-fuctioning but still needs to be de-installed and removed.

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.
NAME OF LICENSING PROGRAM MANAGER: Sergiy Pidgirny
NAME OF LICENSING PROGRAM ANALYST: Rachel A Bruce
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2