107200151-6-21-2024-24-AS-LPAT-D6FNUV-20240621104659

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 107200151
Report Date: 06/21/2024
Date Signed: 06/21/2024 10:47:10 AM

Document Has Been Signed on 06/21/2024 10:47 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:	GARRETT CHRISTIAN HOME		FACILITY NUMBER:	107200151
ADMINISTRATOR:	JAMILI, ERLINDA		FACILITY TYPE:	735
ADDRESS:	5642 E. GARRETT		TELEPHONE:	(559) 497-6220
CITY:	FRESNO	STATE: CA	ZIP CODE:	93727
CAPACITY:	6	CENSUS: 3	DATE:	06/21/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Inthone Milly, Administrator		TIME COMPLETED:	10:55 AM

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	Licensing Program Analyst L. Padgett (LPA), conducted an unannounced annual visit to the facility. LPA stated the purpose of the visit and Staff person, Aida Limatog (DSP) granted entry to this LPA. Administrator (AD) Inthone Milly was called and arrived shortly thereafter. Facility was toured with DSP. At the time of the visit there were no residents in the facility. LPA observed that the kitchen was well maintained with working lights and well maintained appliances. The knives were kept in a locked cabinet. The kitchen counters and sink are free from debris, under the sink are extra sponges. LPA observed a trash can with the lid. LPA observed that refrigerator was kept at a 42 degree F, and the freezer at 0 degree F, well maintained and clean. LPA observed a 2 day perishable food supply. The kitchen cabinets are clean, organized, and had 7 days of non-perishable food. No expired food was observed. DSP opened the medication cabinet for inspection. LPA observed medication cabinet contained medication bins for each resident, labeled and organized. First aid kit was found to contain the required items. LPA observed the dining room is well lit and clean. Dining table has seating for 6. LPA observed the living room has stove fireplace which is inoperable. Television was observed to be in a secure place. LPA observed large sectional sofa. The living room can accommodate at least 10 people. The living room has a sliding glass door that was clean and not obstructed, a table lamp and extra chair. The furniture was clean and in good condition. In the hallway that leads to the bedrooms, LPA observed smoke detector and carbon monoxide detector installed. The smoke alarm and carbon monoxide detectors were tested by the AD and are functioning. A fire

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Lissett Padgett	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: GARRETT CHRISTIAN HOME	FACILITY NUMBER: 107200151
	VISIT DATE: 06/21/2024

NARRATIVE

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A fire extinguisher is mounted on the wall and inspected on 4/3/2024 with the correct pressure gauge as indicated on the meter.

Hallway bathroom is well maintained, well lit, toilet paper, hand soap, a trash can with lid. Water temperature measured at 108.5 degrees F. The bathroom was observed to have non-skid floor, grab bars in shower and near toilet, double sinks, shower bench. The toilet was flushed and is functioning.

LPA observed the linen closet tohave clean towels, linens, blankets is well organized.

Laundry room has washer and dryer, locked cabinet for cleaning supplies.

LPA observed that the garage is well maintained, free from obstructions and debris. The garage has storage cabinets for extra toiletries and non perishable food supply. LPA observed gym equipment.

This facility has 4 bedrooms. 2 are occupied by the residents and 2 are allocated for Staff.

LPA inspected Resident bedroom 1 with DSP. LPA observed Bedroom #1 is shared, has a private bathroom with covered trash bin, cabinets for toiletries, grab bars, and a shower bench. The toilet was flushed and is functioning. The water temperature measured at 108.5 degrees F. The bedroom has good lighting. Required furniture is present and in good condition, the linens are in good condition. Window and screen in good condition.

LPA observed that bedroom #2 is a single bedroom. The bedroom well lit. Window and screen are in good condition. Bedroom has twin bed and required furniture. Closet stores the residents clothing and personal belongings. Furniture and linens are free from stains and are well maintained.

LPA inspected the backyard with DSP it is well maintained, trees, bushes and grass in good condition. Patio chairs and folding table are available for use. The exterior walkways are free from obstructions and debris.

LPA inspected the Staff Rooms with DSP. DSP and AD explained stated that there are live in staff during their shifts and so this is their bedrooms. LPA did not observe any hazards.

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Lissett Padgett	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: GARRETT CHRISTIAN HOME	FACILITY NUMBER: 107200151
	VISIT DATE: 06/21/2024

NARRATIVE

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LPA reviewed residents and staff records with AD and found that all documents are in order and up to date.

LPA is requesting the following documents be submitted to the Fresno CCL office by 6/28/2024: Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance, Emergency and Disaster Plan (LIC 610D) Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020A), Surety Bond

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Lissett Padgett	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024

LIC809 (FAS) - (06/04)

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