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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107200222
Report Date: 09/26/2022
Date Signed: 09/26/2022 11:22:07 AM

Document Has Been Signed on 09/26/2022 11:22 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:
09/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Paulette AvedikianTIME COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA) Katie Brown arrived at the facility unannounced to conduct the Annual Inspection - Infection Control. LPA met with and explained the reason for the visit with Administrator (AD) Paulette Avedikian.

LPA toured the facility inside and out. Upon entry LPA observed sanitizer and visitor log. Covid/symptom/handwashing signs are posted throughout the facility. Furniture in common and dining areas are spaced to promote distancing. Facility has designated visitation areas available. LPA observed resident medication, food supply, paper products, PPE supply and cleaning/disinfecting products. LPA reviewed quarantine/isolation procedures and staff vaccination requirements with AD. LPA reviewed resident Emergency contact information.

AD has agreed to revise and re-implement resident, staff and visitor screening logs.
Additional PPE will be purchased and available for use if needed.

No deficiencies cited during this inspection.

An exit interview was conducted. A copy of this report was left with Paulette Avedikian whose signature confirms receipt of these documents.

LPA requested the following updated forms by 10/6/22: LIC 308, LIC 309, LIC 400, LIC 402, LIC 500, LIC 610E, LIC 9020, Copy of current Liability Coverage. Please provide a copy of revised screenings for review.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Katie Brown
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2022
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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