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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100400070
Report Date: 02/18/2025
Date Signed: 02/18/2025 03:35:15 PM

Document Has Been Signed on 02/18/2025 03:35 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:CALIFORNIA ARMENIAN HOMEFACILITY NUMBER:
100400070
ADMINISTRATOR/
DIRECTOR:		PAUL ROCHAFACILITY TYPE:
741
ADDRESS:6720 E KINGS CANYON RDTELEPHONE:
(559) 251-8414
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY: 392TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
02/18/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Patricia Rea, Human ResourcesTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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On 02/18/2025, Licensing Program Analyst (LPA) Daiquiri Boyd made an unannounced visit to the facility for the purpose of conducting a check of the facility and records to verify that an employee is not employed or on the premises.
Individual named Angelina Padilla has not been employed at this facility since August 30, 2023. This individual was employed at this facillity for approximately two months.

CDSS No. 7924292003
Sergiy PidgirnyTELEPHONE: (559) 243-8080
Daiquiri BoydTELEPHONE: 559-243-8080
DATE: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2025
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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