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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209500
Report Date: 09/23/2024
Date Signed: 09/23/2024 01:06:53 PM

Document Has Been Signed on 09/23/2024 01:06 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:OHANA CARE HOME CENTRAL VALLEY LLCFACILITY NUMBER:
107209500
ADMINISTRATOR/
DIRECTOR:		BARUELA, DARWIN BFACILITY TYPE:
740
ADDRESS:6952 E. ANDREWS AVETELEPHONE:
(559) 862-9471
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY: 6CENSUS: 0DATE:
09/23/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Darwin Baruela & Arlene Baruela TIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On September 23, 2024 Licensing Program Analyst (LPA) Rachel Bruce arrived at the facility for an announced pre licensing inspection. LPA was greeted by Licensee/Administrator and was allowed entry into the facility.

LPA toured the facility inside and out with licensee. LPA entered through the front door and observed the required postings in the entry/dining area. LPA observed the residence to be a single story, 4 bedroom/ 2 bathroom home. There is a dining room and living room observed to have adequate furnishings and lighting. All bedrooms were observed to have beds, personal lighting and chest drawers to accommodate a total of 6 residents - 4 in shared rooms and 2 single rooms.

LPA observed fire extinguisher to be new and charged with a service date of May 13, 2024. Smoke detectors were tested and observed to be operational. Carbon Monoxide detector was observed to be functional and is located in the hallway. Emergency lighting /flashlights and night lights in the hallways by the bathrooms were observed.

LPA observed a adequate supply of towels. A supply of paper towels were observed in the bathrooms. Hot water temperature in bathrooms measured at 110 and 113 degrees F. Non-Skid mats were present in the showers and grab bars were observed.

Kitchen observed to have adequate supply of dshes, plates, pots and pans. Food storage and preparation areas are clean and appropriate for food preparation. Cleaning supplies and chemicals are locked in the garage. A locked cabinet in the dining room is designated to store medications. Sharps/knives were observed in the locked pantry in the kitchen. Appliances observed to be in working order. LPA observed a 7 day supply of non-perishable food.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Rachel A Bruce
LICENSING EVALUATOR SIGNATURE: DATE: 09/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/23/2024
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: OHANA CARE HOME CENTRAL VALLEY LLC
FACILITY NUMBER: 107209500
VISIT DATE: 09/23/2024
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First aid kit was observed and inspected. Washer and Dryer observed in the laundry room with additional storage space available in upper cabinets. Doors and passageways are clear and free from obstruction throughout the home. LPA toured the outside of the residence and observed a covered patio with adequate outdoor seating for activities. A self-latching gate found to be working properly. There is a working fountain located in the back yard. Currently it is covered by a wire fence and will be modified to be in compliance.

Administrator will notify licensing and send LIC 9020 (Resident roster) when first resident is accepted. Comp III completed at today's visit.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Rachel A Bruce
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2024
LIC809 (FAS) - (06/04)
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