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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209599
Report Date: 10/20/2025
Date Signed: 10/20/2025 12:55:49 PM

Document Has Been Signed on 10/20/2025 12:55 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:CARRINGTON OF SHAFTERFACILITY NUMBER:
157209599
ADMINISTRATOR/
DIRECTOR:		JAIME, AMANDA NFACILITY TYPE:
740
ADDRESS:250 E TULARE AVETELEPHONE:
(661) 746-6521
CITY:SHAFTERSTATE: CAZIP CODE:
93263
CAPACITY: 98CENSUS: 45DATE:
10/20/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:53 AM
MET WITH:Steven Aron, Licensee
Zachary Thurm, Licensee
Amanda Jaime, Administrator		TIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On 10/20/2025, Licensing Program Analyst (LPA) M. Medina arrived to the facility for an announced Pre-licensing (Change of Ownership) inspection. LPA met with Licensee and Administrator. There are currently 45 residents in care at time of LPA visit.

LPA toured the facility with Licensee and Administrator. Facility is observed to be a 42 bedrooms with private bathrooms. Common areas were observed to be clean and well lit. Carbon monoxide and smoke alarm detectors were installed and operational. Cleaning and chemical supplies were observed locked in the janitorial closet. Facility’s temperature read 76 degrees F. Fire extinguishers observed throughout facility was a service date of 5/07/2025. Washer and dryer observed in the laundry room with additional linen available. Doors and passageways are clear and free from obstruction throughout the facility. Patio area observed was observed to be to have seating available. Front outdoor area of facility is gated, shaded and has seating available for residents and visitors

Resident’s bedrooms were observed to be adequately furnished with bed, night stand, drawer space, chair, adequate lighting, and linen observed to be in good condition. Hand soap, paper towels, and trash cans with tight fitting lids were observed. Kitchen area toured, menu is posted. Facility observed to have a 2-day supply of perishable and a 7-day supply of non-perishable food available. First aid kit observed to have required items. All medications are locked in medication carts in care station.

Component III was completed. Pre-Licensing is complete and this facility has no deficiencies.

LPA conducted an exit interview was conducted with Licensee and Administrator. A copy of report provided for facility records.

NAME OF LICENSING PROGRAM MANAGER: Sergiy Pidgirny
NAME OF LICENSING PROGRAM ANALYST: Melinda Medina
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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