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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209510
Report Date: 02/04/2025
Date Signed: 02/04/2025 02:14:20 PM

Document Has Been Signed on 02/04/2025 02:14 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:5 STAR RETIREMENT GROUP CORPFACILITY NUMBER:
107209510
ADMINISTRATOR/
DIRECTOR:		OGANYAN, HASMIKFACILITY TYPE:
740
ADDRESS:9282 N VALLEY GREEN DRIVETELEPHONE:
(818) 261-4887
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY: 6CENSUS: 0DATE:
02/04/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Administrator - Jasmine OganyanTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On 02/04/2025 at 1300 hours, Licensing Program Analyst (LPA) M Vega conducted an announced Pre-licensing visit. LPA met with Administrator - Jasmine Oganyan.

LPA began the tour at the entrance of the facility that has one entrance point. LPA toured the inside and outside of the facility. LPA observed no obstruction inside facility.

The facility was observed at a comfortable temperature of 72 degrees Fahrenheit, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. Common areas furnished and well-lit throughout. LPA observed the kitchen to be absent of any trash or debris, sharp objects are secured and inaccessible to residents. At this time, seven day supply of non-perishable food were observed.

Resident’s all bedrooms were observed to be furnished with bed, dresser, night stand, and overhead lightning. Mattresses, box springs, sheets, and linens, were absent of any tears and stains.

Bathrooms and showers were equipped with non-skid mats and securely fastened grab bars. The kitchen water temperature was tested at 117.1 degree Fahrenheit. Towels, linens, and personal hygiene supplies were observed in storage. This facility does have a pool in the backyard, pool perimeter is properly secured with barrier.

All Fire extinguishers are current with service date of 07/26/2024. Carbon monoxide and smoke detectors were observed to be operational.



Continuation on LIC 809C
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Martin Vega
LICENSING EVALUATOR SIGNATURE: DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/04/2025
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: 5 STAR RETIREMENT GROUP CORP
FACILITY NUMBER: 107209510
VISIT DATE: 02/04/2025
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 First Aid Kit was checked and observed to have the required supplies. Emergency exit plan, required phone numbers, and required postings were observed. A working facility telephone number (559-981-5578) was present and functional.

Component III was reviewed with Administrator.

No deficiencies were observed during this visit. Report will be submitted Centralize Application Bureau for record and further processing of application.

SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Martin Vega
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025
LIC809 (FAS) - (06/04)
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