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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107201446
Report Date: 10/31/2024
Date Signed: 10/31/2024 11:21:02 AM

Document Has Been Signed on 10/31/2024 11:21 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:GREEN GABLES CARE HOME IIFACILITY NUMBER:
107201446
ADMINISTRATOR/
DIRECTOR:
ROBERT SHEAKALEEFACILITY TYPE:
740
ADDRESS:1549 DOUGLAS AVENUETELEPHONE:
(559) 297-4152
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
10/31/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Administrator: Robert SheakaleeTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 10/31/24 Licensing Program Analyst (LPA) J. Leffall arrived unannounced to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was greeted by Staff (S1) Marcos Tioanen. LPAs was granted entry. All 5 residents were present during inspection. Designee Mario Ramos (D1) was called and arrived shortly after LPA’s arrival.

LPA toured facility with D1. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. An adequate supply of perishable and non-perishable food was observed. Freezer temperature was maintained at -13 degrees F and refrigerator temperature was maintained at 40 degrees F. Fire extinguisher was observed with a purchase date of: 10/14/24. Fire drill last completed on 9/5/24. Washer and dryer observed operational during visit. Carbon monoxide and smoke detectors were tested and observed to be operational. Residents' bedrooms were toured and observed to be adequately furnished with bed, dresser, and adequate lighting. All bathrooms are toured and observed to be operational. Hot water temperature was tested at a temperature of 116.4 in bathroom 1, 115.5 in bathroom 2 and 116.2 degrees F. in bathroom 3. Non-skid mat and grab bars observed in bathrooms. Outside of facility toured. Side gate was self-closing and self-latching. Outside was observed with adequate outdoor seatings available for residents. Samples of medications was checked and observed kept locked in cabinet. Residents’ MARS was reviewed. First aide kit observed with all of the required items.

All residents files and a samples of staff files reviewed to have all the required documents.



No deficiencies issued during this inspection.

Exit Interview conducted. The following documents requested to be updated and submitted to Fresno CCL by 11/14/24: Lic 308, Lic 500, Lic 610E, Current Liability Insurance and current Administrator’s certificate. A copy of this report was provided to Designee, whose signature on this form confirms receipt of this report.

See MouaTELEPHONE: (559) 580-4596
Jacques LeffallTELEPHONE: 559-243-8080
DATE: 10/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2024
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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