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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107201840
Report Date: 02/17/2024
Date Signed: 02/17/2024 12:44:49 PM


Document Has Been Signed on 02/17/2024 12:44 PM - 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:MARIAN HOMES 3FACILITY NUMBER:
107201840
ADMINISTRATOR:JANARDHAN NAGARAJFACILITY TYPE:
740
ADDRESS:3238 JASMINE AVENUETELEPHONE:
(559) 347-9900
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY:6CENSUS: 5DATE:
02/17/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:08 AM
MET WITH:Shannon SteeleTIME COMPLETED:
12:15 PM
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On 2/17/2024, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required Inspection. LPA introduced self and allowed entrance by Caregiver. Shannon Steele, Care Coordinator contacted by telephone and arrived a short time later to conduct inspection.

Five (5) residents observed to be present during today's inspection. Facility tour conducted with Care Coordinator. Resident bedrooms tour and observed to have required furnishings. Common areas in facility which includes living room and dining room have adequate seating and lighting for residents. Bathrooms toured, LPA observed grab bars near toilet and in shower. Shower also has shower chair and non-slip mats available. Kitchen toured, LPA observed an adequate supply of food for residents in care. All medications observed to be locked and secured in kitchen cabinet. Medications reviewed and observed to have original labels and to be administered as prescribed. All knives were observed to be locked and secured in kitchen cabinet.

Fire extinguisher present and has a service date of 06/07/23. Carbon monoxide detector and smoke detectors present and observed to be operational during today's inspection. Last fire drill conducted 1/29/24 according to facility records.

Outside of facility toured. All exits open free of obstruction. No hazards observed.

Staff and resident files to be reviewed at Annual Continuation.

No deficiencies cited during inspection. Exit interview conducted. A copy of report provided for facility records.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 02/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/17/2024
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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