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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209588
Report Date: 10/03/2025
Date Signed: 10/10/2025 08:36:55 AM

Document Has Been Signed on 10/10/2025 08:36 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:FRESNO GUEST HOME #42FACILITY NUMBER:
107209588
ADMINISTRATOR/
DIRECTOR:
FOWLER, JENNIFERFACILITY TYPE:
740
ADDRESS:2667 E. PALO ALTO AVENUETELEPHONE:
(559) 434-1839
CITY:FRESNOSTATE: CAZIP CODE:
93710
CAPACITY: 6CENSUS: DATE:
10/03/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Teresa Long, AdministratorTIME VISIT/
INSPECTION COMPLETED:
09:55 AM
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Licensing Program Analysts (LPA) Daiquiri Boyd 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 6 bedroom - 4 1/2 bathroom - single story home, with one additional bedroom for the staff. Common areas have adequate furniture and lighting. Flooring is new and intact throughout. Smoke and Carbon Monoxide detectors were tested and found to be in working order. The Fire Extinguisher was purchased 08/07/2025. LPAs observed a supply of extra bed linens and towels in the hallway closet. Personal hygiene and grooming products in the laundry room closet. Resident rooms are found to be in good repair and contained new furnishings and adequate lighting. The resident bathrooms are clean, in good repair with faucets delivering hot water as required at 113.3 F.
The kitchen was observed to have a supply of new 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. Resident medications will be stored in a designated locked closet in the kitchen area. The First Aid kit is new and 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. 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.
NAME OF LICENSING PROGRAM MANAGER: Sergiy Pidgirny
NAME OF LICENSING PROGRAM ANALYST: Daiquiri Boyd
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2025
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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