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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107203181
Report Date: 03/03/2025
Date Signed: 03/03/2025 02:28:34 PM

Document Has Been Signed on 03/03/2025 02:28 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:MUM'S HOME SWEET HOME 2, INC.FACILITY NUMBER:
107203181
ADMINISTRATOR/
DIRECTOR:
STOWELL, JILLFACILITY TYPE:
740
ADDRESS:6711 N. SIERRA VISTA AVENUETELEPHONE:
(559) 299-7520
CITY:FRESNOSTATE: CAZIP CODE:
93710
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
03/03/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Jill StowellTIME VISIT/
INSPECTION COMPLETED:
02:50 PM
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LPA Daiquiri Boyd arrived at the facility unannounced to conduct a Required Annual Inspection. LPA was granted entry by Administrator Jill Stowell. LPA explained the purpose of the visit and met with Administrator Jill Stowell.
A tour of the facility was conducted with the Administrator. The residence was set at 74 F temperature and free of passageway obstructions inside and outside. Facility water temperature measured at 112.6 F. Facility has an infection control plan and an emergency disaster plan. Facility does not currently have any residents on hospice or any with restricted health care plans.

Kitchen toured, supply of food observed and food stored properly for perishable and nonperishable. Medications were stored in a locked medication closet. Cleaning supplies were in a locked closet. Smoke detectors and carbon monoxide detectors were tested and working. Fire extinguisher is 11/19/24. Facility conducted a fire and earthquake drill on 1/6/25.

There was outdoor seating for the residents. Facility has a pool that has a gate which was locked an inaccessible to residents in care.

Resident files and staff files were reviewed. CPR/First Aid is current but expires this month. Staff has scheduled to take the course. Resident medications were reviewed.

LPA requested the following updated forms faxed to CCLD by 03/10/2025: Designation of Facility Responsibility (LIC308), Administrative Organization (LIC309), Personnel Report (LIC 500), Proof of current Liability Coverage.

A copy of this report was provided to the Administrator.

Sergiy PidgirnyTELEPHONE: (559) 243-8080
Daiquiri BoydTELEPHONE: 559-243-8080
DATE: 03/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/03/2025
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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