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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209499
Report Date: 01/31/2025
Date Signed: 01/31/2025 06:22:42 PM

Document Has Been Signed on 01/31/2025 06:22 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:ROBABEHFACILITY NUMBER:
107209499
ADMINISTRATOR/
DIRECTOR:		KHATTAIE, GITAFACILITY TYPE:
740
ADDRESS:3267 E LOS ALTOS AVETELEPHONE:
(559) 304-6314
CITY:FRESNOSTATE: CAZIP CODE:
93710
CAPACITY: 6CENSUS: 0DATE:
01/31/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:30 PM
MET WITH:Gita KhattaieTIME VISIT/
INSPECTION COMPLETED:
06:45 PM
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Licensing Program Analyst (LPA) Daiquiri Boyd arrived at the facility to conduct a Pre-Licensing Inspection. LPA met with Licensee/Administrator (AD) Gita Khattaie.

LPA began the tour by entering through the front door of the 5 bedroom - 5 bathroom home. Common living spaces have new, clean furniture and lighting. Flooring is intact throughout the home. Smoke and Carbon Monoxide detectors were tested and found to be in working order. The Fire Extinguisher was purchased in 12/2024. LPA 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 at 120 F 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 locked as required. Appliances were found to be in working order. Resident medications will be stored in a designated locking dining room closet. The First Aid kit is new and contains all required items. Doors and passageways are unobstructed throughout the inside and outside of the home.

Outside of the facility was toured. There is construction in the backyard that is kept separate by a chain link fence. There is a swimming pool which is enclosed by a locked, wrought iron gate. There is a covered seating area on the back patio. LPA confirmed the facility phone number is activated by calling (559) 470-9206. Required postings are placed.

See continuation of inspection on LIC809C.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Daiquiri Boyd
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2025
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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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: ROBABEH
FACILITY NUMBER: 107209499
VISIT DATE: 01/31/2025
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LPA, together with AD, pulled up the CCLD website and reviewed where to find documents, forms, and information.
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
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Daiquiri Boyd
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025
LIC809 (FAS) - (06/04)
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