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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 207209367
Report Date: 03/13/2025
Date Signed: 03/14/2025 08:43:57 AM

Document Has Been Signed on 03/14/2025 08:43 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:OUR HOUSE - WESTGATEFACILITY NUMBER:
207209367
ADMINISTRATOR/
DIRECTOR:		LENNEMANN, DANAFACILITY TYPE:
740
ADDRESS:2816 WESTAGTE DRIVETELEPHONE:
(559) 661-8961
CITY:MADERASTATE: CAZIP CODE:
93637
CAPACITY: 6CENSUS: 6DATE:
03/13/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Noemi Gallo, AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On March 13, 2025 Licensing Program Analyst Rachel Bruce arrived to conduct an unannounced Case Management visit. LPA arrived, introduced self, stated purpose of visit, and allowed entrance into facility by Program Manager, Corina Garcia. Administrator(AD), Noemi Gallo was called and arrived shortly thereafter to meet with LPA

On January 18, 2025 CCL received an incident report noting that R1 had undone the seat belt of her wheelchair and fell. LPA discussed the incident with AD and ascertained that the resident's medical file contained documentation that the doctor ordered a wheelchair with a seat belt. The family was aware as well as the resident.

Staff monitors the resident but in the situation above the resident chose not to wait for assistance in getting a cup of coffee and ultimately had a fall as a result.

No citations issued at today's visit.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Rachel A Bruce
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2025
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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