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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107200222
Report Date: 08/18/2021
Date Signed: 08/24/2021 09:29:38 AM

Document Has Been Signed on 08/24/2021 09:29 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:AVEDIKIAN HOME #2FACILITY NUMBER:
107200222
ADMINISTRATOR:PAULETTE AVEDIKIANFACILITY TYPE:
735
ADDRESS:7237 N. CECELIA AVENUETELEPHONE:
(559) 275-3229
CITY:FRESNOSTATE: CAZIP CODE:
93722
CAPACITY: 4CENSUS: 2DATE:
08/18/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Paulette AvedikianTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Katie Brown arrived at the facility unannounced to conduct the Infection Control Inspection. LPA met with Administrator Paulette Avedikian. The Covid Contact questionnaire completed at entry. LPA entered through the central entry point. Hand sanitizer was observed at entry and throughout the home.

Facility Mitigation plan has been approved by CCL. LPA reviewed the screening and documentation and Visitation Policy sections with Administrator.

LPA toured the facility inside and out. Required postings to encourage face coverings and hand washing were observed. Furniture in common and dining areas are spaced to promote distancing. Facility has multiple designated visitation areas available. LPA observed 30-day medication supply. Common and resident bathroom sinks are well stocked with liquid soap for hand washing. Both Clients are fully vaccinated.

Through LPA’s observations, documentation review and interview with Administrator, the required infection control practices are found to be in compliance. No deficiencies cited on today’s inspection.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Katie Brown
LICENSING EVALUATOR SIGNATURE: DATE: 08/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/18/2021
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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