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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209557
Report Date: 01/21/2025
Date Signed: 01/21/2025 10:02:47 AM

Document Has Been Signed on 01/21/2025 10:02 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:LEGACYONE RCFE LLCFACILITY NUMBER:
107209557
ADMINISTRATOR/
DIRECTOR:		MAKARYAN, HRIPSIMEFACILITY TYPE:
740
ADDRESS:1933 MORRIS AVENUETELEPHONE:
(559) 433-7896
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY: 6CENSUS: 0DATE:
01/21/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Licensee: Hripsime MakaryanTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) J. Leffall conducted a Pre-licensing Inspection on this day of 1/21/25. LPA met with Licensee Hripsime Makaryan. A tour of the facility was conducted together. This is a new facility with no residents in care. The facility was observed to be at a comfortable temperature, clean, and in good repair. No passageway obstructions or fire hazards were observed inside or outside. Common areas were properly furnished and well-lit throughout. The dining room is equipped with a table and chairs, living room is equipped with adequate sofas and chairs for residents, adequate outside space for rest and recreational. Freezer temperature is maintained at 0 degrees F and refrigerator is maintained at 36 degrees F. Seating and shaded area provided by large patio gazeebo. Gate is self-closing and self-latching.

Perishable and non-perishable food supply appeared adequate. Knives will be locked in kitchen cabinet with medications, and first aid kit. Cleaning and Chemical supplies are kept locked in the laundry room cabinet. Residents' bedrooms were observed to be adequately furnished with bed, dresser, folding chair and adequate lighting. Mattresses and linen were in good condition. Extra linen and towels are available. Carbon monoxide and smoke alarm detectors installed and operational. 2 bathrooms observed with grab bars installed in shower. Bathroom temperature ranged from 109.2 to 112.8 degrees F in both bathrooms. Toilet equipped with grab bars. Non-skid mats in place, hand soap and paper towels available for use. Trash cans with tight fitting lids are in place. Fire extinguisher was serviced and fully charged with a purchase date of 11/21/24. Complaint poster posted, resident council info posted, residents' rights posted; emergency disaster plan posted. First aide kit observed to have all of the required items.

Component III was completed by Licensee. Exit interview was conducted. Pre-licensing requirements were met. An exit interview was conducted with Licensee. Report signed on-site by Licensee and printed copy
provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Jacques Leffall
LICENSING EVALUATOR SIGNATURE: DATE: 01/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/21/2025
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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