<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100400070
Report Date: 02/09/2023
Date Signed: 02/10/2023 08:56:27 AM


Document Has Been Signed on 02/10/2023 08:56 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:CALIFORNIA ARMENIAN HOMEFACILITY NUMBER:
100400070
ADMINISTRATOR:PAUL ROCHAFACILITY TYPE:
741
ADDRESS:6720 E KINGS CANYON RDTELEPHONE:
(559) 251-8414
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY:392CENSUS: DATE:
02/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:02 PM
MET WITH:Paul Rocha, AdministratorTIME COMPLETED:
02:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 02/09/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced at approximately 12:02 PM at the above facility to conduct an Annual Inspection- Infection Control. LPA was directed by front receptionist to Assisted Living building. LPA introduced self, stated the purpose of the visit, and met with Administrator Paul Rocha.

LPA toured Assisted Living building 6694, building 6720 and Memory Care building 6708 with Administrator. Upon entry to each building, staff was observed with facial covering. Visitor log-in/temperature check was observed upon entry at each building. Hand sanitizer was readily available to residents and visitors. Facility has one entrance/exit point for each building. Facility appeared cleaned with no obstruction or fire clearance issues. Social distancing is maintained in the common and dining areas. COVID-19 related signs, cough etiquette postings, and hand washing signs observed in various area throughout facility.

All pathways, entrances and exits were clear from obstructions. No fire clearance issues. Resident’s room toured and observed to be adequately furnished and lit. Residents are single occupant. All bathrooms are observed with securely fastened grab bars and non-skid mat. LPA toured the community kitchen. Food supply was checked and appeared to be an adequate supply. LPA observed a 30-day supply of PPE and residents’ medication. Cleaning supplies was observed stored and locked.

No deficiencies were observed.

Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 2/15/23. The following updated forms were requested: Lic 308, Lic 309, Lic 500, Lic 610E, current Administrator Certificate, and current liability insurance. A copy of this report was provided to Administrator via email. Signature on file.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:
DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/09/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1