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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209488
Report Date: 07/10/2024
Date Signed: 07/10/2024 11:19:33 AM

Document Has Been Signed on 07/10/2024 11:19 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:FRESNO GUEST HOME #22FACILITY NUMBER:
107209488
ADMINISTRATOR/
DIRECTOR:
LONG, TERESAFACILITY TYPE:
740
ADDRESS:6659 N. CHANCE AVENUETELEPHONE:
(559) 434-1839
CITY:FRESNOSTATE: CAZIP CODE:
93710
CAPACITY: 6CENSUS: 0DATE:
07/10/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:48 AM
MET WITH:Teresa LongTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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
Licensing Program Analysts (LPA) Katie Brown and Martin Vega arrived at the facility to conduct a Pre-Licensing Inspection. LPA met with Administrator (AD) Teresa Long.

LPAs began the tour by entering through the front door of the 7 bedroom - 5 bathroom - single story home. Common areas have adequate furniture and lighting. Flooring in intact throughout. Smoke and Carbon Monoxide detectors were tested and found to be I working order. The Fire Extinguisher was purchased 1/16/2014. LPAs observed a supply of extra bed linens, towels, and personal hygiene and grooming products. Resident rooms are found to be in good repair and contained required furnishings and lighting. The resident bathrooms are clean, in good repair with faucets delivering hot water as required.

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. LPA observed the required food supply. Resident medications will be stored in a designated cabinet with lock which is in place. The First aid kit contains all the required items. Doors and passageways are unobstructed throughout the inside of the home.
Outside of the facility was toured. There is a covered seating area and a self-releasing gate found to be working properly. LPA called and confirmed the facility phone number by calling (559) 500-3855. Required postings are placed as required.

Emergency Disaster and Infection Control Plans were reviewed and COMP III was conducted during this visit with AD. The applicant has met all pre-licensing requirements. 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.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Katie Brown
LICENSING EVALUATOR SIGNATURE: DATE: 07/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/10/2024
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 1